Stanchina Michele, Soong Deborah, Zheng-Lin Binbin, Watts Justin M, Taylor Justin
Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
Cancers (Basel). 2020 Nov 1;12(11):3225. doi: 10.3390/cancers12113225.
Acute myeloid leukemia (AML) is a genetically heterogeneous malignancy comprised of various cytogenetic and molecular abnormalities that has notoriously been difficult to treat with an overall poor prognosis. For decades, treatment options were limited to either intensive chemotherapy with anthracycline and cytarabine-based regimens (7 + 3) or lower intensity regimens including hypomethylating agents or low dose cytarabine, followed by either allogeneic stem cell transplant or consolidation chemotherapy. Fortunately, with the influx of rapidly evolving molecular technologies and new genetic understanding, the treatment landscape for AML has dramatically changed. Advances in the formulation and delivery of 7 + 3 with liposomal cytarabine and daunorubicin (Vyxeos) have improved overall survival in secondary AML. Increased understanding of the genetic underpinnings of AML has led to targeting actionable mutations such as , and , and BCL2 or hedgehog pathways in more frail populations. Antibody drug conjugates have resurfaced in the AML landscape and there have been numerous advances utilizing immunotherapies including immune checkpoint inhibitors, antibody-drug conjugates, bispecific T cell engager antibodies, chimeric antigen receptor (CAR)-T therapy and the development of AML vaccines. While there are dozens of ongoing studies and new drugs in the pipeline, this paper serves as a review of the advances achieved in the treatment of AML in the last several years and the most promising future avenues of advancement.
急性髓系白血病(AML)是一种基因异质性恶性肿瘤,由各种细胞遗传学和分子异常组成,其治疗一直 notoriously 困难,总体预后较差。几十年来,治疗选择仅限于基于蒽环类药物和阿糖胞苷方案(7 + 3)的强化化疗或包括低甲基化药物或小剂量阿糖胞苷在内的低强度方案,随后进行异基因干细胞移植或巩固化疗。幸运的是,随着快速发展的分子技术的涌入和新的遗传学认识,AML 的治疗格局发生了巨大变化。脂质体阿糖胞苷和柔红霉素(Vyxeos)的 7 + 3 配方和给药方式的进展提高了继发性 AML 的总生存率。对 AML 遗传基础的进一步了解导致在更脆弱的人群中靶向可操作的突变,如 、 和 ,以及 BCL2 或刺猬通路。抗体药物偶联物在 AML 领域重新出现,并且在利用免疫疗法方面取得了许多进展,包括免疫检查点抑制剂、抗体药物偶联物、双特异性 T 细胞衔接抗体、嵌合抗原受体(CAR)-T 疗法以及 AML 疫苗的开发。虽然有几十项正在进行的研究和新药物正在研发中,但本文旨在回顾过去几年 AML 治疗取得的进展以及最有前景的未来发展途径。