Division of Hematology, University of Washington and Member, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Am J Hematol. 2014 Nov;89(11):1063-81. doi: 10.1002/ajh.23834.
Evidence suggests that even patients aged 70 or above benefit from specific AML therapy. The fundamental decision in AML then becomes whether to recommend standard or investigational treatment. This decision must rest on the likely outcome of standard treatment. Hence we review factors that predict treatment related mortality and resistance to therapy, the latter the principal cause of failure even in patients aged 70 or above. We emphasize the limitations of prediction of resistance based only on pre-treatment factors and stress the need to incorporate post-treatment factors, for example indicators of minimal residual disease. We review various newer therapeutic options and considerations that underlie the decision to recommend allogeneic hematopoietic cell transplant.
有证据表明，即使是 70 岁或以上的患者也能从特定的 AML 治疗中获益。那么，AML 治疗的基本决策就变成了是否推荐标准治疗还是探索性治疗。这一决策必须基于标准治疗的可能结果。因此，我们回顾了预测治疗相关死亡率和治疗抵抗的因素，即使是 70 岁或以上的患者，治疗抵抗也是失败的主要原因。我们强调了仅基于治疗前因素预测治疗抵抗的局限性，并强调需要纳入治疗后因素，例如微小残留病灶的指标。我们回顾了各种新的治疗选择和决策推荐异基因造血细胞移植的基础考虑因素。
