Treatment of acute myeloid leukemia: are we making progress?
Treatment of acute myeloid leukemia: are we making progress?
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DOI：
10.1182/asheducation-2012.1.1
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发表时间：
2012-12-01
影响因子：
3
通讯作者：
Burnett, Alan K.
中科院分区：
文献类型：
--
作者：
Burnett, Alan K.
除了少数亚群例外，如具有更有利遗传疾病的年轻患者，急性髓性白血病的治疗进展缓慢。改善缓解的质量有可能降低复发的风险。柔红霉素剂量的增加、抗体定向化疗的增加以及诱导中核苷类似物的替代可能取代“3 + 7”柔红霉素+阿糖胞苷（Ara-C）作为诱导的长期标准，并且一些预后因素正在出现，使诱导后治疗的方法更加个性化，特别是患者应在首次缓解时提供同种异体移植。除了提供预后信息外，分子表征还提供了潜在的治疗靶点，在某些情况下，还提供了更精确地监测残留疾病的机会。除了少数例外，预后因素的预测价值（即采取何种治疗）尚未确定。一个主要的挑战是老年急性髓性白血病（AML）患者的治疗，他们代表了这种疾病的大多数患者。只有大约一半的老年AML患者通过常规化疗进入完全缓解（CR），其中大多数在2年内复发。在过去的30年里，这些令人沮丧的结果几乎没有什么影响，需要新的治疗方法和试验设计方法。另一个值得关注的人群是老年AML患者，由于担心他们承受治疗后果的能力，他们被认为不适合采用强化治疗方法。这个群体不容易客观地定义，但年龄是一个有用的替代，因为它与更多的化疗耐药疾病和医学合并症有关。老年患者是一项治疗挑战，但一些新的治疗方法可能会改善他们的状况。
With a few subgroups as exceptions, such as younger patients with more favorable genetic disease, improvement in the treatment of acute myeloid leukemia has been slow. There is a possibility that improving the quality of remission can reduce the risk of relapse. Escalation of daunorubicin dose, addition of Ab-directed chemotherapy, and alternative nucleoside analogs in induction may displace the longstanding standard of "3 + 7" daunorubicin + cytarabine (Ara-C) as induction, and several prognostic factors are emerging that enable a more personalized approach to postinduction treatment, in particular, which patients should be offered allogeneic transplantation in first remission. In addition to providing prognostic information, molecular characterization provides potential therapeutic targets and, in some cases, an opportunity to more precisely monitor residual disease. With few exceptions, the predictive value of prognostic factors (ie, what therapy to adopt) has yet to be established. A major challenge is the treatment of older patients with acute myeloid leukemia (AML), who represent the majority of patients with this disease. Only about half of older AML patients will enter complete remission (CR) with conventional chemotherapy and, of these, most will relapse within 2 years. Little impact has been made on these dismal outcomes over the past 3 decades, and new treatments and approaches to trial design are required. Another population of concern is older AML patients who are not considered to be fit for an intensive approach based on concerns about their ability to withstand the consequences of treatment. This group is not easy to define objectively, but age represents a useful surrogate because it is associated with more chemoresistant disease and medical comorbidity. Older patients represent a therapeutic challenge, but several new treatments may offer some potential to improve their situation.