Blum Sabine, Greve Gabriele, Lübbert Michael
aService and Central Laboratory of Hematology, CHUV, University Hospital of Lausanne, Lausanne, Switzerland bDivision of Hematology, Oncology and Stem Cell Transplantation, Department of Internal Medicine, Faculty of Medicine, University of Freiburg Medical Center cFaculty of Biology, University of Freiburg dDKTK, German Consortium for Translational Cancer Research, Freiburg, Germany.
Curr Opin Hematol. 2017 Mar;24(2):89-98. doi: 10.1097/MOH.0000000000000318.
Adverse karyotype acute myeloid leukemia is a disease particularly of older patients, but also observed in younger patients. Despite all efforts, standard chemotherapy is still generally applied in fit patients, as already for decades, and for nearly all different subtypes of acute myeloid leukemia. Lack of more specifically targeted therapy and the often older age of the patients are complicating treatment, and in the subgroup of patients achieving a complete remission, the strikingly high frequency of relapse is a characteristic of this disease. This review aims to give an overview of current treatment approaches as well as emerging therapies.
Currently, the approach of a targeted therapy specific to the genetic and/or epigenetic aberrations detected in the individual patient is still not possible, and a 'one treatment fits all' course of action is still used, with allografting as curative consolidation. However, first immunotherapeutic approaches are emerging as treatment options and first phase 1 and 2 studies are described.
Treatment of acute myeloid leukemia with adverse karyotype is still not individualized, most treatment options currently not being curative. This can change in the near future, but recent findings will have to be implemented into larger phase 3 studies before being standard of care.
具有不良核型的急性髓系白血病主要发生于老年患者，但也可见于年轻患者。尽管付出了诸多努力，但标准化疗仍普遍应用于适合接受化疗的患者，且已沿用数十年，几乎适用于所有不同亚型的急性髓系白血病。缺乏更具针对性的治疗方法以及患者往往年龄较大，使得治疗变得复杂，在实现完全缓解的患者亚组中，极高的复发率是该疾病的一个特征。本综述旨在概述当前的治疗方法以及新兴疗法。
目前，针对个体患者检测到的基因和/或表观遗传异常进行靶向治疗的方法仍不可行，仍采用“一刀切”的治疗方案，将同种异体移植作为根治性巩固治疗。然而，首批免疫治疗方法正在成为治疗选择，并已开展了首批1期和2期研究。
具有不良核型的急性髓系白血病的治疗仍未实现个体化，目前大多数治疗方案无法治愈。在不久的将来这种情况可能会改变，但在成为标准治疗之前，最近的研究结果必须纳入更大规模的3期研究。
