Aldoss Ibrahim T, Marcucci Guido, Pullarkat Vinod
Oncology (Williston Park). 2016 Dec 15;30(12):1080-91.
Although pediatric acute lymphoblastic leukemia (ALL) has cure rates of over 90%, adult ALL remains a challenging disease to treat, with cure rates roughly half those seen in children. The inferior outcomes in adults can be attributed mainly to adverse genetic features, as well as the inability-particularly of older adults-to tolerate chemotherapy. Modest improvements have been seen in outcomes for adolescents and young adults; these can largely be attributed to the use of pediatric-type combination chemotherapy regimens in patients aged 50 years or younger. In patients with Philadelphia chromosome-positive ALL, once a very-high-risk group, outcomes have markedly improved as a result of the use of tyrosine kinase inhibitors in combination with chemotherapy. The persistence of minimal residual disease has emerged as the single most important prognostic factor for ALL and is increasingly being used to help make decisions regarding allogeneic hematopoietic stem cell transplantation or novel salvage therapies. Relapsed/refractory ALL has had a dismal prognosis. In recent years, novel immune-based therapies have been developed that have shown impressive results and that have the potential to improve the outcome of relapsed ALL. These include antibody-drug conjugates, the bispecific T-cell-engaging antibody blinatumomab, and chimeric antigen receptor-modified T cells.
尽管小儿急性淋巴细胞白血病（ALL）的治愈率超过90%，但成人ALL仍然是一种难以治疗的疾病，其治愈率约为儿童的一半。成人ALL预后较差主要归因于不良的基因特征，以及尤其是老年成人耐受化疗的能力不足。青少年和年轻成人的预后有一定改善；这在很大程度上可归因于50岁及以下患者使用了儿科类型的联合化疗方案。在费城染色体阳性ALL患者中，这曾经是一个极高风险组，由于使用酪氨酸激酶抑制剂联合化疗，其预后已显著改善。微小残留病的持续存在已成为ALL最重要的单一预后因素，并且越来越多地被用于帮助做出关于异基因造血干细胞移植或新型挽救治疗的决策。复发/难治性ALL的预后一直很差。近年来，已开发出新型免疫疗法，这些疗法已显示出令人印象深刻的结果，并有可能改善复发ALL的结局。这些疗法包括抗体药物偶联物、双特异性T细胞接合抗体blinatumomab和嵌合抗原受体修饰的T细胞。
