Medinger Michael, Passweg Jakob R
Division of Haematology, University Hospital Basel, Basel, Switzerland.
Division of Internal Medicine, University Hospital Basel, Basel, Switzerland.
Br J Haematol. 2017 Nov;179(4):530-542. doi: 10.1111/bjh.14823. Epub 2017 Jun 27.
Acute myeloid leukaemia (AML) is a biologically complex, molecularly and clinically heterogeneous disease. Despite major advances in understanding the genetic landscape of AML and its impact on the pathophysiology and biology of the disease, standard treatment options have not significantly changed during the past three decades. AML is characterized by multiple somatically acquired mutations that affect genes of different functional categories. Mutations in genes encoding epigenetic modifiers, such as DNMT3A, ASXL1, TET2, IDH1, and IDH2, are commonly acquired early and are present in the founding clone. By contrast, mutations involving NPM1 or signalling molecules (e.g., FLT3, RAS gene family) are typically secondary events that occur later during leukaemogenesis. This review aims to provide an overview of advances in new prognostic markers, including targetable mutations that will probably guide the development and use of novel molecularly targeted therapies.
急性髓系白血病(AML)是一种生物学复杂、分子和临床异质性的疾病。尽管在了解AML的基因图谱及其对疾病病理生理学和生物学的影响方面取得了重大进展,但在过去三十年中,标准治疗方案并没有显著改变。AML的特征是多个体细胞获得性突变,这些突变影响不同功能类别的基因。编码表观遗传修饰因子的基因,如DNMT3A、ASXL1、TET2、IDH1和IDH2中的突变,通常在早期获得,并存在于起始克隆中。相比之下,涉及NPM1或信号分子(如FLT3、RAS基因家族)的突变通常是白血病发生后期出现的继发事件。本综述旨在概述新的预后标志物的进展,包括可能指导新型分子靶向治疗的开发和应用的可靶向突变。