Vasudevan Nampoothiri Ram, Viswabandya Auro
Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, 610 University Avenue, Toronto, ON M5G 2M9 Canada.
Indian J Hematol Blood Transfus. 2021 Oct;37(4):521-527. doi: 10.1007/s12288-020-01334-4. Epub 2020 Aug 12.
Therapy related acute leukemia consists of a unique subset of acute leukemia with an increased frequency of high risk cytogenetic and molecular abnormalities, dismal response to therapy, higher relapse rates and poor overall survival. Therapy related acute myeloid leukemia (t-AML) is a better defined disease entity than therapy related acute lymphoid leukemia (t-ALL). However, in recent times, t-ALL is also being increasingly recognized and extensively studied. Therapy related acute myeloid leukemia is usually classified together with therapy related myelodysplastic syndrome. However, the management of these two diseases maybe different regarding needs of induction chemotherapy and eligibility for upfront allogeneic hematopoietic stem cell transplantation (Allo HSCT). There is also evidence regarding differences in prognosis and outcomes between these two entities. Allo HSCT offers a potential for cure in t-AML and t-ALL. However, existing literature on the same is confounded by inclusion of t-MDS and secondary acute leukemias. Here we review the current evidence on the outcomes and predictors of outcomes of Allo HSCT in the management of therapy related acute leukemias. We also shed light into the under-representation of therapy related leukemias in clinical trials. This stresses the need for prospective trials incorporating measurable residual disease monitoring and sequential next generation sequencing based genomic data for accurate prognostication and management of therapy related acute leukemia.
治疗相关急性白血病是急性白血病中的一个独特亚组，具有高风险细胞遗传学和分子异常的频率增加、对治疗反应不佳、复发率较高以及总体生存率较差的特点。与治疗相关的急性髓系白血病（t-AML）是一个比治疗相关急性淋巴细胞白血病（t-ALL）定义更明确的疾病实体。然而，近年来，t-ALL也越来越受到认可并得到广泛研究。治疗相关急性髓系白血病通常与治疗相关骨髓增生异常综合征归为一类。然而，这两种疾病在诱导化疗需求和前期异基因造血干细胞移植（Allo HSCT）的适用性方面的管理可能有所不同。也有证据表明这两种实体在预后和结局方面存在差异。Allo HSCT为治愈t-AML和t-ALL提供了可能。然而，关于这方面的现有文献因纳入了t-MDS和继发性急性白血病而混淆。在此，我们综述了关于Allo HSCT在治疗相关急性白血病管理中的结局及结局预测因素的当前证据。我们还揭示了治疗相关白血病在临床试验中代表性不足的问题。这强调了开展前瞻性试验的必要性，这些试验应纳入可测量残留病监测以及基于连续下一代测序的基因组数据，以准确预测和管理治疗相关急性白血病。
