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青少年和年轻成人急性淋巴细胞白血病:波兰视角。

Acute Lymphoblastic Leukemia in Adolescents and Young Adults: A Polish Perspective.

机构信息

Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznań, Poland.

Poznan University of Medical Sciences, Poznań, Poland.

出版信息

J Adolesc Young Adult Oncol. 2022 Feb;11(1):1-5. doi: 10.1089/jayao.2021.0033. Epub 2021 Jul 7.

Abstract

Acute lymphoblastic leukemia (ALL) is a disease that affects immature lymphocytes in the blood and presents a high prevalence rate in children and adolescent young adult (AYA) populations (15-39 years). AYAs are a unique group who face a significant therapeutic disadvantage when treated with the adult regimen, as evident with lower remission rates, whereas the opposite is true in children. A recent study by EUROCARE-5 showed a marked decrease with age in 5 years relative to survival outcomes based on cancer registries of 27 European countries: 85.8% for patients 0-14 years of age and a decreased 62.2% and 52.8% for patients 15-19 and 20-39 years, respectively. There is growing evidence demonstrating that the pediatric ALL treatment regimen is effective and beneficial when treating AYAs. Treatment of ALL in AYAs around the world is showing improved remission rates with therapeutic advancements and increasing amount of data available with updated clinical trials and regimens. The addition of l-asparaginase into adult treatment regimens has significantly increased the remission rates. This administration to AYAs is more difficult but shows a positive benefit in comparison with the toxicity ratio. This review article will discuss the controversy of AYA patients diagnosed with ALL treated with pediatric or adult protocols and their perspectives in Poland and will focus on ALL etiology, epidemiology, and prognostic factors with comparison of compliance of medications between both populations of patients.

摘要

急性淋巴细胞白血病(ALL)是一种影响血液中未成熟淋巴细胞的疾病,在儿童和青少年及年轻成人(AYA)人群中发病率较高(15-39 岁)。AYA 是一个独特的群体,他们在接受成人治疗方案时面临着显著的治疗劣势,因为缓解率较低,而在儿童中则相反。最近的一项由 EUROCARE-5 进行的研究表明,根据 27 个欧洲国家癌症登记处的结果,与基于年龄的生存结果相比,5 年内年龄相关的缓解率显著下降:0-14 岁患者为 85.8%,15-19 岁患者为 62.2%,20-39 岁患者为 52.8%。越来越多的证据表明,儿科 ALL 治疗方案在治疗 AYA 时是有效且有益的。全世界对 AYA 中 ALL 的治疗显示出随着治疗进展,缓解率有所提高,并且随着更新的临床试验和方案,可用的数据量也在增加。在成人治疗方案中添加 L-天冬酰胺酶显著提高了缓解率。这种方法对 AYA 来说更困难,但与毒性比相比具有积极的益处。本文将讨论在波兰对诊断为 ALL 的 AYA 患者采用儿科或成人方案治疗的争议,以及 ALL 的病因、流行病学和预后因素,并比较两种患者人群对药物的依从性。

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