Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA 91010, USA.
Blood. 2013 Feb 14;121(7):1077-82. doi: 10.1182/blood-2012-08-234492. Epub 2012 Dec 14.
Although the majority of adult patients with both acute lymphoblastic leukemia and acute myelogenous leukemia achieve remission with upfront chemotherapy, many patients still suffer relapse. Often, the strategy is proposed of treating patients with relapsed leukemia into a second remission (CR2) and then proceeding to allogeneic transplantation as the definitive curative approach. However, the long-term outcomes of such a strategy are poor: the 5-year overall survival from first relapse for patients with acute leukemia is only approximately 10%. This Perspective highlights the fact that most patients do not achieve CR2 and therefore never really have an opportunity for a potential curative therapy. Although patients who undergo transplantation after relapse may be cured, those who do not achieve CR2 are rarely candidates for transplantation; therefore, the overall outcome for patients who relapse is dismal. There is therefore an urgent need not only for more effective upfront therapy to prevent relapse, but also for the development of therapies that can serve as effective bridging treatments between relapse and transplantation. We suggest that more optimal use of minimal residual disease detection during first remission may also improve the chances for successful transplantation therapy via earlier reinduction therapy, allowing transplantation before overt relapse.
尽管大多数急性淋巴细胞白血病和急性髓细胞白血病的成年患者通过初始化疗达到缓解，但许多患者仍会复发。通常，建议对复发的白血病患者进行第二次缓解（CR2）治疗，然后作为确定性治疗方法进行同种异体移植。然而，这种策略的长期结果很差：首次复发的急性白血病患者的 5 年总生存率仅约为 10%。本观点强调了一个事实，即大多数患者并未达到 CR2，因此从未真正有机会接受潜在的治愈性治疗。尽管在复发后进行移植的患者可能被治愈，但未达到 CR2 的患者很少有资格进行移植；因此，复发患者的总体预后不佳。因此，不仅需要更有效的初始治疗来预防复发，还需要开发在复发和移植之间作为有效桥接治疗的疗法。我们建议，在首次缓解期间更优化地利用微小残留病检测，也可以通过更早的再诱导治疗来提高成功移植治疗的机会，从而在明显复发之前进行移植。
