Leukemia Service, Department of Medicine, Weill Cornell Medical College, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
Hematol Oncol Clin North Am. 2011 Dec;25(6):1189-213. doi: 10.1016/j.hoc.2011.09.007.
Although the past decade has brought improvements in the treatment of AML, particularly for younger individuals, most patients succumb to the disease. With current induction therapy, most patients achieve remission, but the optimal strategy for post-remission therapy is unclear. Refinements to risk classification systems that incorporate additional molecular markers may better guide physicians in recommendations for postremission therapy. The prognosis for older patients with AML remains uniformly poor, because only a minority can benefit from intensive chemotherapy and novel HCT strategies. Despite active investigation, no standard of care has emerged for patients who are not suitable candidates for standard induction therapy. The development of less toxic, more effective therapies for this population is sorely needed. Advances in molecular genetics, immunology, and the biology of normal and malignant hematopoiesis pathogenesis have led to an improved understanding of the pathogenesis of AML and to the discovery of potential therapeutic targets. Until a greater proportion of individuals with AML attain long-term survival, patients should routinely be referred to cancer centers and enrolled in investigational studies.
尽管过去十年在 AML 的治疗方面取得了进展，尤其是对于年轻患者，但大多数患者仍无法治愈。目前的诱导疗法可使大多数患者获得缓解，但缓解后治疗的最佳策略尚不清楚。改进风险分类系统，纳入更多的分子标志物，可能有助于医生为缓解后治疗提供建议。对于 AML 老年患者，预后仍然普遍较差，因为只有少数患者能够从强化化疗和新型 HCT 策略中获益。尽管积极探索，但对于不适合标准诱导治疗的患者，尚无标准的治疗方法。迫切需要为这部分人群开发毒性更小、更有效的治疗方法。分子遗传学、免疫学和正常及恶性造血发生的生物学方面的进展，使人们对 AML 的发病机制有了更好的了解，并发现了潜在的治疗靶点。在更多的 AML 患者获得长期生存之前，应常规将患者转介至癌症中心，并纳入研究。
