Muffly Lori S, Reizine Natalie, Stock Wendy
Stanford University Medical Center, Stanford, California.
Adolescent and Young Adult Oncology Program, University of Chicago Medicine, Chicago, Illinois.
Clin Adv Hematol Oncol. 2018 Feb;16(2):138-146.
Substantial interest in acute lymphoblastic leukemia (ALL) in young adults (YAs) and investigations focused on this patient population have resulted in therapeutic advancements that are changing the management paradigm and improving outcomes. The pediatric ALL approach is feasible and effective when administered by medical oncologists. Advanced diagnostics and minimal residual disease measurements aid in prognostication and have resulted in shifting recommendations regarding allogeneic hematopoietic cell transplant in first remission. Blinatumomab, inotuzumab, and chimeric antigen receptor T-cell therapies are transforming the treatment of relapsed/refractory ALL. This comprehensive review of the current management of ALL in YAs summarizes recent scientific developments and clinical trial findings related to ALL biology, frontline management approaches, novel therapies, and supportive care specific to this patient population. Finally, a practical guide to modern YA management for practicing clinicians is provided.
对年轻成人急性淋巴细胞白血病(ALL)的大量关注以及针对这一患者群体的研究带来了治疗进展,这些进展正在改变管理模式并改善治疗结果。当由医学肿瘤学家实施时,儿科ALL治疗方法是可行且有效的。先进的诊断方法和微小残留病检测有助于预后评估,并导致了关于首次缓解期异基因造血细胞移植建议的转变。博纳吐单抗、伊尼妥单抗和嵌合抗原受体T细胞疗法正在改变复发/难治性ALL的治疗方式。这篇对年轻成人ALL当前管理的全面综述总结了与ALL生物学、一线管理方法、新疗法以及针对该患者群体的支持性护理相关的近期科学进展和临床试验结果。最后,为临床执业医生提供了一份关于年轻成人ALL现代管理的实用指南。