Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Cancer. 2022 Jan 15;128(2):240-259. doi: 10.1002/cncr.33933. Epub 2021 Oct 6.
Progress is occurring at a dizzying rate across all leukemias. Since the authors' review of the topic in Cancer in 2018, numerous discoveries have been made that have improved the therapy and outcomes of several leukemia subsets. Hairy cell leukemia is potentially curable with a single course of cladribine followed by rituximab (10-year survival, ≥90%). Acute promyelocytic leukemia is curable at a rate of 80% to 90% with a nonchemotherapy regimen of all-trans retinoic acid and arsenic trioxide. The cure rate for core-binding factor acute myeloid leukemia (AML) is ≥75% with fludarabine, high-dose cytarabine, and gemtuzumab ozogamicin. Survival for patients with chronic myeloid leukemia is close to that for an age-matched normal population with BCR-ABL1 tyrosine kinase inhibitors (TKIs). Chronic lymphocytic leukemia, a previously incurable disease, may now be potentially curable with a finite duration of therapy with Bruton tyrosine kinase inhibitors and venetoclax. The estimated 5-year survival rate for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (ALL) exceeds 70% with intensive chemotherapy and ponatinib, a third-generation BCR-ABL1 TKI, and more recent nonchemotherapy regimens using dasatinib or ponatinib with blinatumomab are producing outstanding results. Survival in both younger and older patients with ALL has improved with the addition of antibodies targeting CD20, CD19 (blinatumomab), and CD22 (inotuzumab) to chemotherapy. Several recent drug discoveries (venetoclax, FLT3 and IDH inhibitors, and oral hypomethylating agents) are also improving outcomes for younger and older patients with AML and for those with higher risk myelodysplastic syndrome.
所有白血病的治疗进展都在迅速推进。自作者 2018 年在《癌症》杂志上对该主题进行综述以来，已经有许多新的发现，这些发现改善了几种白血病亚群的治疗效果和预后。采用克拉屈滨单药治疗，随后采用利妥昔单抗治疗，可使毛细胞白血病达到潜在治愈效果（10 年生存率≥90%）。采用全反式维甲酸和三氧化二砷的非化疗方案，急性早幼粒细胞白血病的治愈率可达 80%至 90%。采用氟达拉滨、高剂量阿糖胞苷和吉妥珠单抗奥佐米星治疗核心结合因子急性髓系白血病（AML）的治愈率≥75%。采用 BCR-ABL1 酪氨酸激酶抑制剂（TKI）治疗，慢性髓性白血病患者的生存率与年龄匹配的正常人群相近。慢性淋巴细胞白血病是一种以前无法治愈的疾病，现在可能通过有限疗程的布鲁顿酪氨酸激酶抑制剂和 venetoclax 治疗达到治愈。接受强化化疗和 ponatinib（第三代 BCR-ABL1 TKI）治疗以及最近使用 dasatinib 或 ponatinib 联合 blinatumomab 的非化疗方案治疗的费城染色体阳性急性淋巴细胞白血病（ALL）患者的 5 年生存率超过 70%，预后显著改善。在 ALL 患者中，无论是年轻患者还是老年患者，通过在化疗中添加针对 CD20、CD19（blinatumomab）和 CD22（inotuzumab）的抗体，生存状况都得到了改善。最近的一些药物发现（venetoclax、FLT3 和 IDH 抑制剂以及口服低甲基化剂）也改善了年轻和老年 AML 患者以及高危骨髓增生异常综合征患者的预后。
