Division of Pediatric Hematology/Oncology, New York University Langone Medical Center, New York, NY, USA.
Hematology Am Soc Hematol Educ Program. 2012;2012:129-36. doi: 10.1182/asheducation-2012.1.129.
Acute lymphoblastic leukemia (ALL) is the most common and one of the most treatable cancers in children. Although the majority of children with ALL are now cured, 10%-20% of patients are predicted to relapse and outcomes with salvage therapy have been disappointing, with approximately only one-third of children surviving long-term after disease recurrence. Several prognostic factors have been identified, with timing of recurrence relative to diagnosis and site of relapse emerging as the most important variables. Despite heterogeneity in the elements of salvage therapy that are delivered in trials conducted internationally, outcomes have been remarkably similar and have remained static. Because most intensive salvage regimens have reached the limit of tolerability, current strategies are focusing on identifying new agents tailored to the unique biology of relapsed disease and identifying methods to develop these agents efficiently for clinical use. Recently, high-resolution genomic analyses of matched pairs of diagnostic and relapse bone marrow samples are emerging as a promising tool for identifying pathways that impart chemoresistance.
急性淋巴细胞白血病（ALL）是儿童中最常见且最具治疗潜力的癌症之一。尽管大多数 ALL 患儿现已治愈，但仍有 10%-20%的患者预计会复发，挽救性治疗的结果并不理想，大约只有三分之一的患儿在疾病复发后能够长期生存。目前已经确定了一些预后因素，复发的时间相对于诊断和复发部位是最重要的变量。尽管国际临床试验中采用的挽救性治疗方案在元素上存在异质性，但结果却非常相似，而且一直保持不变。由于大多数强化挽救方案已经达到耐受极限，因此目前的策略主要集中在确定针对复发疾病独特生物学特性的新药物，并寻找有效的方法将这些药物开发用于临床。最近，对诊断和复发骨髓样本的配对进行高分辨率基因组分析，正在成为鉴定赋予化疗耐药性的途径的有前途的工具。
