Hematology-Oncology Division, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Blood. 2015 Jul 30;126(5):589-96. doi: 10.1182/blood-2014-09-551937. Epub 2015 May 12.
The long-term prognosis of adult patients with relapsed Philadelphia chromosome-negative acute lymphoblastic lymphoma (ALL) is poor. Allogeneic stem cell transplant in second remission is the only curative approach and is the goal when feasible. There is no standard chemotherapy regimen for relapsed disease, although a few agents are approved for use in this setting. The bispecific CD19-directed CD3 T-cell engager, blinatumomab, has recently been granted accelerated approval by the US Food and Drug Administration for relapsed or refractory disease of B-cell lineage. For patients with relapsed T-cell ALL, nelarabine is available. Liposomal vincristine is also approved for relapsed disease. When selecting combination chemotherapy salvage options, evaluation of the prior treatment and timing of relapse informs treatment decisions. Monoclonal and cellular investigational therapies are quite promising and should be explored in the appropriate patient.
费城染色体阴性成人复发急性淋巴细胞白血病（ALL）患者的长期预后较差。同种异体造血干细胞移植在第二次缓解期是唯一的治愈方法，也是可行时的目标。尽管有几种药物已被批准用于该治疗环境，但复发疾病没有标准的化疗方案。双特异性 CD19 导向的 CD3 T 细胞衔接器blinatumomab 最近已被美国食品和药物管理局加速批准用于 B 细胞谱系复发或难治性疾病。对于复发 B 细胞 ALL 患者，有 nelarabine 可用。脂质体长春新碱也可用于治疗复发疾病。在选择联合化疗挽救方案时，既往治疗的评估和复发时间决定了治疗决策。单克隆和细胞的研究性治疗方法非常有前途，应在适当的患者中进行探索。
