Department of Pharmacy, MD Anderson Cancer Center, Houston, Texas 77030, USA.
Oncology (Williston Park). 2012 Sep;26(9):851-9.
Acute lymphoblastic leukemia (ALL) in adults is a very challenging disease. Adults tend to present with higher-risk features and are unable to tolerate chemotherapy regimens as intense as those administered to children. The overall treatment plan for adult ALL is modeled after the pediatric paradigm and includes multi-agent chemotherapy in the forms of induction, consolidation, maintenance, and central nervous system prophylaxis. Most patients will go into complete remission but often relapse; relapse is typically indicative of chemotherapy-refractory disease. Salvage therapy generally consists of cytotoxic agents from drug classes the patient has had limited or no exposure to. The results of conventional chemotherapy for relapsed ALL are unacceptable. The goal of therapy in these patients is to achieve a second remission followed by allogeneic stem-cell transplantation. Monoclonal antibodies directed at cell-surface antigens offer a targeted approach to treating leukemia and other cancers. Anti-CD20 monoclonal antibodies have been shown to improve survival when used in the frontline setting. Novel, highly active antibodies directed at CD19 and CD22 are being investigated in the relapsed and refractory settings. These agents will likely be explored as components of first-line therapy as clinical development continues.
成人急性淋巴细胞白血病（ALL）是一种极具挑战性的疾病。成人患者往往具有更高的风险特征，无法耐受像儿童患者那样强烈的化疗方案。成人 ALL 的整体治疗方案是仿照儿科模式制定的，包括诱导、巩固、维持和中枢神经系统预防等多种联合化疗。大多数患者会达到完全缓解，但往往会复发；复发通常表明化疗耐药性疾病。挽救治疗通常包括患者接触有限或没有接触过的药物类别的细胞毒性药物。复发性 ALL 的常规化疗结果令人无法接受。这些患者治疗的目标是实现第二次缓解，然后进行异基因干细胞移植。针对细胞表面抗原的单克隆抗体为治疗白血病和其他癌症提供了一种靶向方法。抗 CD20 单克隆抗体在一线治疗中已被证明可提高生存率。针对 CD19 和 CD22 的新型、高活性抗体正在复发和难治性环境中进行研究。随着临床开发的继续，这些药物可能会作为一线治疗的一部分进行探索。
