Department of Pediatrics, Division of Pediatric Hematology-Oncology, David Geffen School of Medicine, University of California, Los Angeles, USA.
Department of Medicine, Division of Hematology-Oncology, David Geffen School of Medicine, University of California, Los Angeles, USA.
Blood Rev. 2018 Mar;32(2):122-129. doi: 10.1016/j.blre.2017.09.005. Epub 2017 Sep 21.
Acute lymphoblastic leukemia (ALL) is one of the most common cancer diagnoses identified in adolescents and young adults (AYAs). Although most children with ALL are cured of their disease, AYAs have experienced much worse outcomes over time, with event-free survival ranging from 30 to 45%. This survival disparity is likely due to differences in tumor biology, treatment-related toxicities, and nonmedical issues. This review summarizes these differences as well as focusing on the various trials that have demonstrated superior outcomes with pediatric protocols in AYAs with ALL. Even with the widespread use of these protocols, a treatment gap remains, and novel therapies are one way to address this problem. Still, these therapies also have significant toxicities and unique issues that need to be tested further, especially in the AYA population. The development of more AYA-specific trials will be an important way to examine novel therapies and interventions designed to reduce treatment-related toxicities and improve long-term outcomes.
急性淋巴细胞白血病（ALL）是青少年和年轻成年人（AYAs）中最常见的癌症诊断之一。尽管大多数儿童 ALL 患者已治愈，但随着时间的推移，AYAs 的预后却明显更差，无事件生存率在 30%至 45%之间。这种生存差异可能归因于肿瘤生物学、治疗相关毒性和非医学问题的差异。本综述总结了这些差异，并重点介绍了各种临床试验，这些试验表明，采用儿科方案治疗 ALL 的 AYAs 可获得更好的结果。即使广泛使用这些方案，仍存在治疗差距，新的治疗方法是解决这一问题的途径之一。不过，这些疗法也存在严重的毒性和独特的问题，需要进一步测试，尤其是在 AYA 人群中。开展更多针对 AYA 的临床试验将是检验旨在降低治疗相关毒性和改善长期预后的新型疗法和干预措施的重要途径。
