Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Center of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Curr Opin Hematol. 2024 Mar 1;31(2):47-52. doi: 10.1097/MOH.0000000000000795. Epub 2023 Nov 20.
Despite higher remission and survival rates than observed in adults, children with acute myeloid leukemia (AML) still suffer unacceptably high rates of treatment failure and late toxicities. Ongoing work aims to improve these long-term outcomes through improvements in the utilization of current therapies, the incorporation of novel chemotherapy agents, and improved use of current or novel cellular and immunotherapeutic approaches. In this review, we highlight recent advances and contextualize them within this evolving landscape.
Novel agents such as the B-cell lymphoma 2 inhibitor venetoclax and the menin inhibitors have shown promising results with implications for large portions of the pediatric AML population. Older agents are being used in novel combinations (e.g. gemtuzumab ozogamicin) or are expanding into pediatrics after longer use in adults (e.g. Fms-like tyrosine kinase 3 inhibitors). Finally, immunotherapeutic approaches offer new options for patients with high-risk or relapsed disease.
Recent findings have altered the landscape of pediatric AML therapy with exciting immediate and long-term implications. Ongoing studies may soon define this as standard as well. After many years in which few new therapies have become available for children with AML, recent and upcoming advances may soon dramatically alter the therapeutic landscape.
目的综述:尽管儿童急性髓系白血病(AML)的缓解率和生存率高于成年人,但治疗失败和晚期毒性的发生率仍然高得令人无法接受。目前的工作旨在通过改进现有治疗方法的应用、加入新的化疗药物以及改进现有或新型细胞和免疫治疗方法来改善这些长期结果。在这篇综述中,我们强调了最近的进展,并将其置于不断发展的背景下。
最新发现:新型药物,如 B 细胞淋巴瘤 2 抑制剂 venetoclax 和 menin 抑制剂,已经显示出有希望的结果,对儿科 AML 患者的大部分人群都有影响。旧的药物正在被用于新的组合(例如 gemtuzumab ozogamicin),或者在成人中使用更长时间后扩展到儿科(例如 Fms 样酪氨酸激酶 3 抑制剂)。最后,免疫治疗方法为高危或复发疾病患者提供了新的选择。
总结:最近的发现改变了儿科 AML 治疗的格局,具有令人兴奋的即时和长期影响。正在进行的研究可能很快就会将其定义为标准。在多年来很少有新的疗法可用于治疗儿童 AML 之后,最近和即将出现的进展可能很快就会极大地改变治疗格局。