Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA.
Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA.
Ann Oncol. 2023 Feb;34(2):141-151. doi: 10.1016/j.annonc.2022.11.004. Epub 2022 Nov 21.
Acute myeloid leukemia (AML) is a heterogeneous disease at the genetic level. The field of AML therapy is increasingly shifting away from uniform approaches based solely on intensive chemotherapy (such as '7 + 3') toward personalized therapy. The treatment of AML can now be individualized based on patient characteristics and cytogenetic/molecular disease features. In this review, we provide a comprehensive updated summary of personalized, target-directed therapy in AML. We first discuss the selection of intensive versus low-intensity treatment approaches based on the patient's age and/or comorbidities. We follow with a detailed review of specific molecularly defined AML subtypes that benefit from the addition of targeted agents. In this context, we highlight the urgent need for novel therapies in tumor protein p53 (TP53)-mutated AML. We then propose approaches to optimize AML therapy in patients without directly actionable mutations. We conclude with a discussion on the emerging role of using measurable residual disease to modify therapy based on the quality of response.
急性髓系白血病（AML）在遗传水平上是一种异质性疾病。AML 治疗领域正逐渐从单纯基于强化化疗（如“7+3”）的统一方法转向个体化治疗。现在可以根据患者特征和细胞遗传学/分子疾病特征对 AML 进行个体化治疗。在这篇综述中，我们全面更新了 AML 个体化、靶向治疗的综述。我们首先讨论了根据患者年龄和/或合并症选择强化与低强度治疗方法。然后，我们详细回顾了特定的分子定义的 AML 亚型，这些亚型受益于靶向药物的加入。在这方面，我们强调了迫切需要针对肿瘤蛋白 p53（TP53）突变 AML 的新型疗法。接下来，我们提出了在没有直接可操作突变的患者中优化 AML 治疗的方法。最后，我们讨论了基于反应质量使用可测量残留疾病来修改治疗的新兴作用。
