Kansagra Ankit, Litzow Mark
Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Curr Hematol Malig Rep. 2017 Jun;12(3):187-196. doi: 10.1007/s11899-017-0377-y.
Young adults with acute lymphoblastic leukemia are a distinctive category of patients, with substantial difference in disease biology and response to therapy; hence, they pose unique challenges and issues beyond those faced by children and older adults. Despite inferior survival compared to children, there is growing evidence to suggest that young adults have improved outcomes when treated with pediatric-based approaches. With better supportive care and toxicity management and multidisciplinary team and approach, we have made great improvement in outcomes of young adults with ALL. However, despite significant progress, patients with persistence of minimal residual disease have a poor prognosis. This review discusses current controversies in the management of young adults with ALL, outcomes following pediatric and adult protocols, and the role of allogeneic stem cell transplantation. We also explore recent advances in disease monitoring and highlight our approach to incorporation of novel therapies in the management of young adults with ALL.
患有急性淋巴细胞白血病的年轻成年人是一类独特的患者群体，其疾病生物学特性和对治疗的反应存在显著差异；因此，他们面临着儿童和老年人所没有的独特挑战和问题。尽管与儿童相比生存率较低，但越来越多的证据表明，采用基于儿科的治疗方法时，年轻成年人的治疗效果有所改善。随着更好的支持性护理、毒性管理以及多学科团队和方法的应用，我们在患有急性淋巴细胞白血病的年轻成年人的治疗效果方面取得了巨大进步。然而，尽管取得了重大进展，但仍有微小残留病持续存在的患者预后较差。本综述讨论了患有急性淋巴细胞白血病的年轻成年人管理中的当前争议、儿科和成人方案后的治疗效果以及异基因干细胞移植的作用。我们还探讨了疾病监测的最新进展，并强调了我们在患有急性淋巴细胞白血病的年轻成年人管理中纳入新疗法的方法。
