Tomizawa Daisuke, Adachi Souichi
Division of Leukemia and Lymphoma, Children's Cancer Center, National Center for Child Health and Development.
Department of Human Health Sciences, Kyoto University.
Rinsho Ketsueki. 2017;58(8):1038-1046. doi: 10.11406/rinketsu.58.1038.
It is well known that adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL) should be treated based on pediatric ALL protocol, which could yield better survival rates. However, an optimal treatment strategy for AYAs with acute myeloid leukemia (AML) is not yet established and corresponding data are limited. Compared with ALL, clinical and biological characteristics of pediatric and adult AML are relatively similar. Moreover, treatment strategy is quite similar, although pediatric protocols are more intensive and transplant indications are narrower. Previous reports show that AYAs with AML have similar to relatively lower survival rates and higher treatment-related mortality than children with AML. These results indicated that intensive pediatric chemotherapy is effective for preventing AML relapse in AYAs but higher toxicity rates compensates overall survival. To improve the outcomes of AYAs with AML, it is essential to develop optimal intensive chemotherapy, introduce novel targeted therapies, and adopt better risk stratification, particularly to determine appropriate transplant indications. These strategies should be accomplished by close cooperation between pediatric hematologists/oncologists and adult hematologists.
众所周知，患有急性淋巴细胞白血病（ALL）的青少年和青年（AYA）应根据儿童ALL方案进行治疗，这可能会带来更好的生存率。然而，针对患有急性髓系白血病（AML）的AYA的最佳治疗策略尚未确立，相应的数据也很有限。与ALL相比，儿童和成人AML的临床和生物学特征相对相似。此外，治疗策略也相当相似，尽管儿童方案更强化，移植指征更窄。先前的报告显示，患有AML的AYA与患有AML的儿童相比，生存率相似或相对较低，且治疗相关死亡率较高。这些结果表明，强化的儿童化疗对预防AYA中的AML复发有效，但较高的毒性率抵消了总体生存率。为了改善患有AML的AYA的治疗结果，开发最佳的强化化疗、引入新型靶向治疗以及采用更好的风险分层至关重要，特别是要确定合适的移植指征。这些策略应由儿童血液学家/肿瘤学家和成人血液学家密切合作来完成。
