Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
Acta Haematol. 2014;132(3-4):292-7. doi: 10.1159/000360200. Epub 2014 Sep 10.
Treating adolescents and young adults (AYAs) diagnosed with cancer is a challenge. Acute myeloid leukemia (AML) which is usually diagnosed in a previously healthy kid, requiring immediate aggressive chemotherapy, brings difficulties and conflicts associated with severe illness to extremes. The incidence of AML in adolescents aged 15-19 years approaches 8.5 per million. Only in recent years has it become evident that the prognosis of AYAs diagnosed with AML is poorer compared to younger children diagnosed with AML with similar characteristics. No specific genetic aberration or other known poor risk factor was found to explain the inferior prognosis of AYAs. In acute lymphoblastic leukemia the contribution of differences between adult and pediatric protocols to AYA outcome is established. It has been suggested that pediatric protocols should also apply to AYAs with AML; however, data supporting this are vague. Herein, existing evidence regarding special considerations in treating AYAs with AML is discussed. Mental and psychological age-specific aspects important to consider when treating AYAs with AML are overviewed. Awareness for adolescent special needs, adherence to protocols and intensive supportive care are important. Multidisciplinary adolescent-oriented staff should be involved in the therapy of any AYA with AML escorting this special patient population on the road to cure.
治疗被诊断患有癌症的青少年和年轻成年人（AYAs）是一个挑战。急性髓细胞白血病（AML）通常在之前健康的孩子中诊断出来，需要立即进行积极的化疗，将与重病相关的困难和冲突推向极端。15-19 岁青少年中 AML 的发病率接近每百万分之 8.5。直到最近几年，人们才明显意识到，与具有相似特征的年轻儿童相比，被诊断患有 AML 的 AYAs 的预后较差。没有发现特定的遗传异常或其他已知的不良风险因素可以解释 AYAs 预后较差的原因。在急性淋巴细胞白血病中，成人和儿科方案之间的差异对 AYA 结局的贡献已得到确立。有人建议，儿科方案也应适用于患有 AML 的 AYAs；然而，支持这一观点的数据尚不清楚。本文讨论了治疗 AML 的 AYAs 时需要特别考虑的现有证据。综述了治疗 AML 的 AYAs 时需要考虑的心理和心理年龄特异性方面。了解青少年的特殊需求、遵守方案和强化支持性护理非常重要。应让多学科的面向青少年的工作人员参与任何患有 AML 的 AYA 的治疗，陪伴这一特殊患者群体走向治愈之路。
