Cassano W F, Eskenazi A E, Frantz C N
University of Maryland School of Medicine, Baltimore.
Curr Opin Oncol. 1993 Jan;5(1):42-52.
Recent advances in therapy for childhood acute lymphoblastic leukemia have come primarily from the intensive laboratory study of patient's lymphoblasts. DNA-ploidy determination, the analysis of specific chromosomal translocations, and in vitro chemosensitivity studies now facilitate the stratification of risk groups and the prediction of treatment outcome. More is known about the heterogeneity of molecular defects involved in leukemogenesis, and this information is being exploited to devise sensitive tests for minimal residual disease. Conventional chemotherapy of childhood acute lymphoblastic leukemia is associated with adverse neuropsychological sequelae and second malignancies when intensive epipodophyllotoxin therapy is used. Treatment of relapsed acute lymphoblastic leukemia remains problematic. The development of alternative donor marrow sources will expand the role of bone marrow transplantation, which has provided better outcomes for a limited number of patients. We are still waiting to spawn novel therapeutic agents that are more effective and less toxic than present chemotherapy.
儿童急性淋巴细胞白血病治疗的最新进展主要源于对患者淋巴母细胞的深入实验室研究。DNA倍性测定、特定染色体易位分析以及体外化学敏感性研究如今有助于对风险组进行分层并预测治疗结果。我们对白血病发生过程中涉及的分子缺陷的异质性有了更多了解，并且正在利用这些信息设计针对微小残留病的敏感检测方法。当使用强化的鬼臼毒素治疗时，儿童急性淋巴细胞白血病的传统化疗会伴有不良的神经心理后遗症和继发性恶性肿瘤。复发性急性淋巴细胞白血病的治疗仍然存在问题。替代供体骨髓来源的发展将扩大骨髓移植的作用，骨髓移植已为少数患者带来了更好的治疗效果。我们仍在期待研发出比现有化疗药物更有效且毒性更低的新型治疗药物。
