Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, N.Y., USA.
Acta Haematol. 2014;132(3-4):264-73. doi: 10.1159/000360204. Epub 2014 Sep 10.
The cure rate of acute lymphoblastic leukemia (ALL) in children is 80%, compared to less than half in adults. A major proportion of this cure rate drop occurs in adolescents and young adults (AYAs). The age range defining this population varies between studies, biological characteristics are different from both younger children and older adults, and AYAs are treated either by pediatric or adult oncologists, who often apply different treatment approaches to the same ALL patient population. The outcome of AYAs aged 15-21 years treated by more contemporary pediatric protocols is similar to that of younger children but is inferior when using adult regimens. This motivated studying AYA patients, including those above the age of 21 years, with pediatric or 'pediatrics-inspired' regimens that intensified nonmyelosuppressive drugs such as vincristine, steroids and asparaginase, with very promising preliminary results. Discovering new mutations in AYA ALL will help stratify patients into risk subgroups and identify targets for novel agents. This, together with fine-tuning pediatric chemotherapy principles will hopefully finally decrease the cure rate gap between children and AYAs - and even older adults.
儿童急性淋巴细胞白血病 (ALL) 的治愈率为 80%，而成人则不到一半。治愈率下降的主要原因是青少年和年轻成年人（AYAs）。该人群的年龄范围在不同的研究中有所不同，其生物学特征与年幼儿童和老年成年人不同，而且 AYAs 由儿科或成人肿瘤学家治疗，他们通常对同一 ALL 患者人群采用不同的治疗方法。按照更现代的儿科方案治疗的年龄在 15-21 岁的 AYAs 的结果与年幼儿童相似，但使用成人方案时则较差。这促使我们研究包括年龄超过 21 岁的 AYA 患者，使用儿科或“受儿科启发”的方案，强化非骨髓抑制药物，如长春新碱、类固醇和门冬酰胺酶，取得了非常有前景的初步结果。发现 AYA ALL 中的新突变将有助于将患者分层为风险亚组，并确定新型药物的靶标。这与微调儿科化疗原则一起，有望最终缩小儿童和 AYAs 之间的治愈率差距——甚至与老年成年人的差距。
