Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Curr Hematol Malig Rep. 2020 Aug;15(4):276-293. doi: 10.1007/s11899-020-00585-2.
Tremendous advances have been made in the treatment armamentarium for acute lymphoblastic leukemia in recent years, which have substantially improved outcomes for these patients. At the same time, unique toxicities have emerged, and without early intervention, are life-threatening. This article will review the novel therapies in acute leukemias and highlight the clinically relevant supportive care advances.
The American Society for Transplantation and Cellular Therapy (ASTCT) has put forth the most recent recommendations in managing the cytokine release syndrome and neurotoxicity after chimeric antigen receptor T cells (CAR-T) and blinatumomab. The hepatic injury incurred by inotuzumab, and the vascular toxicity of tyrosine kinase inhibitors, other relatively novel agents, require subspecialist intervention and multidisciplinary care. Asparaginase, a long-established and key element of pediatric regimens, has made a comeback in the young adult leukemia population. Updated guidelines have been outlined for management of asparaginase thrombotic complications. Lastly, although there have been few changes in the applications of growth factor, antimicrobial prophylaxis, and management of neuropathy, these encompass exceedingly important aspects of care. While the rapidly changing treatment paradigms for acute lymphoblastic leukemia have transformed leukemia-specific outcomes, treatment emergent toxicities have forced much necessary attention to better definitions of these toxicities and on improving supportive care guidelines in acute lymphoblastic leukemia.
近年来，急性淋巴细胞白血病的治疗方法有了巨大的进步，这大大改善了患者的预后。与此同时，也出现了独特的毒性，如果不及时干预，这些毒性可能会危及生命。本文将综述急性白血病的新型治疗方法，并重点介绍相关的临床支持治疗进展。
美国移植和细胞治疗学会（ASTCT）提出了关于嵌合抗原受体 T 细胞（CAR-T）和blinatumomab 后细胞因子释放综合征和神经毒性的最新治疗建议。依妥珠单抗引起的肝损伤和酪氨酸激酶抑制剂等相对新型药物的血管毒性需要专科医生的干预和多学科的护理。天冬酰胺酶作为儿科方案的重要组成部分，在年轻成年白血病患者中又重新得到应用。目前已经为天冬酰胺酶血栓并发症的管理制定了更新的指南。最后，尽管生长因子、抗菌预防和神经病变管理的应用几乎没有变化，但这些涵盖了护理中非常重要的方面。尽管急性淋巴细胞白血病的治疗模式发生了快速变化，改变了白血病特异性的预后，但治疗引起的毒性迫使我们更加关注这些毒性的定义，并改善急性淋巴细胞白血病的支持治疗指南。
