Gökbuget Nicola
Department of Medicine II, Goethe University Hospital, Theodor Stern Kai 7, 60590, Frankfurt, Germany.
Drugs Aging. 2018 Jan;35(1):11-26. doi: 10.1007/s40266-017-0503-5.
The outcome of adult acute lymphoblastic leukaemia (ALL) has improved significantly during the past decade, mainly due to intensive paediatric-based chemotherapy. Less improvement has been observed in older patients. A significantly lower rate of complete remissions, higher early mortality, higher relapse rate and poorer survival is observed in older compared with younger ALL patients. Most importantly, intensive chemotherapy with or without stem-cell transplantation is less well tolerated in older patients. In addition, there is an increasing incidence of poor prognostic factors with increasing age. Progress has been made with the development of age-adapted, moderately intensive chemotherapy protocols for Ph/BCR-ABL-negative ALL and combinations of tyrosine kinase inhibitors with chemotherapy in Ph/BCR-ABL-positive ALL. Future progress can be expected from new targeted therapies, particularly novel immunotherapies, moderately intensified consolidation strategies and reduced intensity stem-cell transplantation. For this purpose, prospective clinical trials for older patients are urgently needed.
在过去十年中，成人急性淋巴细胞白血病（ALL）的治疗结果有了显著改善，这主要归功于以儿童化疗方案为基础的强化治疗。老年患者的改善相对较少。与年轻ALL患者相比，老年患者的完全缓解率显著降低、早期死亡率更高、复发率更高且生存率更低。最重要的是，无论是否进行干细胞移植，强化化疗在老年患者中的耐受性都较差。此外，随着年龄增长，不良预后因素的发生率也在增加。对于Ph/BCR-ABL阴性ALL，已开发出适合年龄的中度强化化疗方案；对于Ph/BCR-ABL阳性ALL，酪氨酸激酶抑制剂与化疗联合应用也取得了进展。新的靶向治疗，特别是新型免疫疗法、适度强化的巩固策略以及降低强度的干细胞移植有望带来未来的进展。为此，迫切需要针对老年患者开展前瞻性临床试验。
