Treatment of acute promyelocytic leukemia for older patients.

Treatment of acute promyelocytic leukemia for older patients.
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DOI:
10.6004/jnccn.2011.0030
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发表时间:
2011-03
期刊:
Journal of the National Comprehensive Cancer Network : JNCCN
影响因子:
--
通讯作者:
Gore SD
Gore SD
中科院分区:
其他
文献类型:
--
作者:
Prebet T;Gore SD

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急性早幼粒细胞白血病(APL)是一种显著的疾病,其中白血病的发生是由PML-RARα癌基因驱动的,对于这种疾病,以全反式维甲酸(ATRA)为基础的靶向治疗有很大的治愈机会。APL见于一小部分老年患者,年龄是治疗结果最重要的预后因素之一。与其他急性白血病不同,老年APL患者的不良预后与疾病生物学变化关系较小,而与ATRA毒性增加以及用于诱导血液学和分子反应的化疗联合方案关系更大。使用毒性较低的药物(如三氧化二砷)的风险适应策略使老年患者能够获得更高的效率和更大的治愈机会。
Acute promyelocytic leukemia (APL) represents a remarkable disease in which leukemogenesis is driven by the PML-RARα oncogene and for which targeted treatment with all-trans retinoic acid (ATRA)–based therapy allows substantial chance of cure. APL is seen in a small subset of older patients, with age representing one of the most important prognostic factors for outcome of treatment. Unlike other acute leukemias, the inferior outcomes for APL in older patients relates less to changes in disease biology and more to increased toxicity of ATRA and chemotherapy combination regimens used to induce hematologic and molecular responses. Risk-adapted strategies that use less-toxic agents, such as arsenic trioxide, allow treatment of older patients, with greater efficiency and better chances of cure.
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