New Approaches to Treating Challenging Subtypes of ALL in AYA Patients.

New Approaches to Treating Challenging Subtypes of ALL in AYA Patients.
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DOI:
10.1007/s11899-020-00597-y
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发表时间:
2020-12
影响因子:
2.9
通讯作者:
Wynne J
Wynne J
中科院分区:
医学3区
文献类型:
--
作者:
Prescott K;Jacobs M;Stock W;Wynne J

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随着儿科启发方案的采用,青少年和年轻成人(AYA)患者的急性淋巴细胞白血病(ALL)治疗得到了显著改善。然而,仍有几种ALL亚型代表着重大的治疗挑战。在这里,我们回顾了目前的证据指导治疗费城染色体阳性(Ph+),费城染色体样(Ph-L),早期T细胞前体(ETP)ALL的AYA人口。Ph+ ALL的临床试验已证明第二代和第三代酪氨酸激酶抑制剂(TKI)诱导和维持缓解的上级疗效。目前的工作重点是确定这些缓解的持久性以及哪些患者将从移植中受益。对于Ph样和ETP ALL,最近的研究正在研究在标准治疗中添加新药物。在添加强效TKI后,Ph+ ALL的治疗显著改善。然而,Ph样和ETP ALL的治疗仍然是一个挑战。此时,明智地使用同种异体移植是目前唯一的方法来改变这种增加的风险。
The treatment of acute lymphoblastic leukemia (ALL) in adolescent and young adult (AYA) patients has markedly improved with the adoption of pediatric-inspired protocols. However, there remain several subtypes of ALL that represent significant therapeutic challenges. Here, we review the current evidence guiding treatment of Philadelphia chromosome positive (Ph+), Philadelphia chromosome-like (Ph-L), and Early T precursor (ETP) ALL in the AYA population. Clinical trials in Ph+ ALL have demonstrated the superior efficacy of second and third generation tyrosine kinase inhibitors (TKIs) to induce and maintain remission. Current efforts now focus on determining the durability of these remissions and which patients will benefit from transplant. For Ph-like and ETP ALL, recent studies are investigating the addition of novel agents to standard treatment. The treatment of Ph+ ALL has significantly improved with the addition of potent TKIs. However, the treatment of Ph-like and ETP ALL remains a challenge. At this time, the judicious use of allogenic transplant is the only current approach to modify this increased risk.
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