Stanford Cancer Center, 875 Blake Wilbur Drive, Stanford, CA 94305-5821, USA.
Expert Rev Hematol. 2011 Apr;4(2):173-84. doi: 10.1586/ehm.11.10.
Cytogenetic analysis at diagnosis is one of the most significant prognostic factors in acute myeloid leukemia (AML). AML patients with unfavorable-risk cytogenetic abnormalities account for 16-30% of younger adult patients and have poor response to standard treatment, with only 32-55% achieving a complete response. Overall survival is also extremely poor with only 5-12% patients alive at 5-10 years after diagnosis. Owing to the poor response in this subset of patients, risk-adapted treatment has been investigated. Allogeneic stem cell transplant has been shown to provide a survival benefit in patients with unfavorable-risk cytogenetic abnormalities in complement receptor 1. Other risk-adapted treatment strategies, such as reduced-intensity conditioning regimens prior to allogeneic stem cell transplant for older patients with AML, have also shown some survival benefit, without increasing treatment-related toxicities. Risk-stratification models that include cytogenetic abnormalities, as well as other molecular markers, are being developed to allow for individualized risk-adapted treatment for patients with AML. Prospective multicenter trials will be needed to validate these prognostic models.
诊断时的细胞遗传学分析是急性髓细胞白血病（AML）最重要的预后因素之一。年轻成年 AML 患者中存在 16-30%具有不良预后细胞遗传学异常的患者，对标准治疗反应不佳，仅有 32-55%的患者达到完全缓解。总体生存率也极差，仅 5-12%的患者在诊断后 5-10 年内存活。由于这部分患者的反应不佳，因此已经研究了风险适应性治疗。在补体受体 1 存在不良预后细胞遗传学异常的患者中，异体造血干细胞移植已被证明可提供生存获益。对于年龄较大的 AML 患者，在异体造血干细胞移植前采用强度降低的预处理方案等其他风险适应性治疗策略也显示出一定的生存获益，而不会增加治疗相关毒性。正在开发包括细胞遗传学异常以及其他分子标志物在内的风险分层模型，以实现 AML 患者的个体化风险适应性治疗。需要进行前瞻性多中心试验来验证这些预后模型。
