A basis for updating our approach to resistant acute leukemia
A basis for updating our approach to resistant acute leukemia
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DOI：
10.1002/ajh.22256
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发表时间：
2012-03-01
影响因子：
12.8
通讯作者：
Cunningham, Isabel
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文献类型：
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作者：
Cunningham, Isabel
目前还没有研究证明，在一个大的肿瘤患者群体中，化疗单独根除由白血病细胞组成的肿瘤。然而，在没有数据的情况下，它的使用持续了40多年。共识协议只存在于睾丸和脑膜肿瘤，依赖于局部治疗。为了在一个部位构建关于肿瘤的知识体系，选择乳房并分析所有已发表的病例，并获得随访，以记录急性白血病肿瘤的行为和表现后的生存率。在235例（2000年以来发表的52%）中，总生存率很低，特别是43%伴有形态学骨髓复发的患者，一年死亡率为66-73%。106例单纯化疗患者中仅4例存活4年。大多数AML和ALL肿瘤仅对抗白血病治疗（包括移植）有一过性反应，并且在进一步的肿瘤中比在骨髓中更常见或更常见。一个模式的肿瘤类似于转移的浸润性小叶乳腺癌被发现。当骨髓复发时，很少获得持久缓解。这些数据表明，在前瞻性试验中纳入诊断和复发时的疾病检查程度可能会带来潜在益处。这可能会产生一个准确的发生率髓外肿瘤和一种手段，以确定潜在的残留疾病，可能导致骨髓复发。这种方法可能会在治疗急性白血病方面取得更大的成功。Am. J. Hematol. 2012. (c)2011 Wiley Periodicals，Inc.
No studies exist documenting that chemotherapy alone eradicates tumors composed of leukemic cells in a large group of patients with tumors at any one site. Yet, its use has continued over 40 years in the absence of data. Consensus protocols exist only for testis and meningeal tumors, relying on local therapy. To constitute a body of knowledge about tumors at one site, the breast was chosen and all published cases were analyzed, with follow-up obtained, to document the behavior of acute leukemia tumors and survival after presentation. Among 235 cases (52% published since 2000), overall survival was poor, particularly for the 43% with concurrent morphologic marrow relapse, with 66-73% one-year mortality. Only 4 of 106 patients treated with chemotherapy alone survived 4 years. The majority of AML and ALL tumors were only transiently responsive to anti-leukemia treatments, including transplant, and next relapses were as, or more, common in further tumors than in marrow. A pattern of tumors similar to the metastases of invasive lobular breast cancer was revealed. When relapse occurred in marrow, durable remission was only rarely obtained. These data suggest a potential benefit of incorporating extent of disease workup at diagnosis and relapse into prospective trials. This could yield an accurate incidence of extramedullary tumors and a means to identify occult residual disease which could lead to marrow relapse. This approach could potentially result in greater success in curing acute leukemias. Am. J. Hematol. 2012. (c) 2011 Wiley Periodicals, Inc.