治疗青少年 ALL 中具有挑战性亚型的新方法。
New Approaches to Treating Challenging Subtypes of ALL in AYA Patients.
机构信息
Department of Medicine, University of Chicago Medicine, 900 E. 57th Street, 8th Floor, Chicago, IL, 60637, USA.
出版信息
Curr Hematol Malig Rep. 2020 Dec;15(6):424-435. doi: 10.1007/s11899-020-00597-y.
PURPOSE OF REVIEW
The treatment of acute lymphoblastic leukemia (ALL) in adolescent and young adult (AYA) patients has markedly improved with the adoption of pediatric-inspired protocols. However, there remain several subtypes of ALL that represent significant therapeutic challenges. Here, we review the current evidence guiding treatment of Philadelphia chromosome-positive (Ph+), Philadelphia chromosome-like (Ph-L), and early T-precursor (ETP) ALL in the AYA population.
RECENT FINDINGS
Clinical trials in Ph + ALL have demonstrated the superior efficacy of second- and third-generation tyrosine kinase inhibitors (TKIs) to induce and maintain remission. Current efforts now focus on determining the durability of these remissions and which patients will benefit from transplant. For Ph-like and ETP ALL, recent studies are investigating the addition of novel agents to standard treatment. The treatment of Ph + ALL has significantly improved with the addition of potent TKIs. However, the treatment of Ph-like and ETP ALL remains a challenge. At this time, the judicious use of allogenic transplant is the only current approach to modify this increased risk.
目的综述
采用儿科启发式方案显著改善了青少年和年轻成人（AYA）患者急性淋巴细胞白血病（ALL）的治疗效果。然而，仍有几种 ALL 亚型具有显著的治疗挑战。在此，我们综述了目前指导费城染色体阳性（Ph+）、费城染色体样（Ph-L）和早期 T 前体（ETP）ALL 在 AYA 人群中治疗的证据。
最近的发现
Ph+ALL 临床试验表明，第二代和第三代酪氨酸激酶抑制剂（TKI）在诱导和维持缓解方面具有更好的疗效。目前的努力集中在确定这些缓解的持久性以及哪些患者将从移植中受益。对于 Ph-Like 和 ETP ALL，最近的研究正在调查在标准治疗中添加新型药物。随着强效 TKI 的加入，Ph+ALL 的治疗已显著改善。然而，Ph-Like 和 ETP ALL 的治疗仍然是一个挑战。目前，同种异体移植的合理应用是改变这种高风险的唯一方法。
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