Department of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, Ontario, Canada.
Curr Oncol Rep. 2011 Oct;13(5):371-8. doi: 10.1007/s11912-011-0185-9.
Treatment approaches for adolescents and young adults with acute lymphoblastic leukemia (ALL) have evolved considerably in the past 5-7 years. One of the major changes has been the widespread adoption of pediatric-based protocols, which appears to have significantly improved survival and probably renders allogeneic hematopoietic stem cell transplantation (HSCT) unnecessary in most standard-risk patients. However, high-risk patients, such as those with BCR-ABL or MLL rearrangements or high white count presentations, should still be referred for HSCT in CR-1. Minimal residual disease positivity has also been identified as a high-risk feature. Patients with BCR-ABL-positive ALL should receive combined therapy with a tyrosine kinase inhibitor and chemotherapy prior to HSCT. The adoption of pediatric-based regimens has been associated with significant additional toxicities, including venous thromboembolism, osteonecrosis, other steroid-related changes, and neuropathy, which can potentially have a major adverse impact on the quality of life of these young ALL patients.
在过去的 5-7 年中，青少年和年轻成人急性淋巴细胞白血病 (ALL) 的治疗方法有了很大的发展。主要变化之一是广泛采用基于儿科的方案，这似乎显著提高了生存率，并且可能使大多数标准风险患者不再需要异体造血干细胞移植 (HSCT)。然而，高危患者，如存在 BCR-ABL 或 MLL 重排或高白细胞计数表现的患者，仍应在 CR-1 时转介进行 HSCT。微小残留病阳性也被确定为高危特征。BCR-ABL 阳性 ALL 患者应在 HSCT 前接受酪氨酸激酶抑制剂联合化疗。采用基于儿科的方案与显著增加的毒性相关，包括静脉血栓栓塞、骨坏死、其他类固醇相关变化和神经病，这可能对这些年轻 ALL 患者的生活质量产生重大不利影响。
