Therapy-related Leukemia and Myelodysplasia: Evolving Concepts of Pathogenesis and Treatment
Therapy-related Leukemia and Myelodysplasia: Evolving Concepts of Pathogenesis and Treatment
复制标题
治疗相关白血病和骨髓增生异常：发病机制和治疗概念的演变
作者：
D. Rund;D. Ben
摘要治疗相关白血病和治疗相关骨髓发育不良(t-AML/MDS)是细胞毒化疗和/或放射治疗的严重和日益频繁的并发症。可区分两种综合征，其中一种潜伏期较长(5-7年或更长时间)，常见于烷基化药物后，通常伴有先期发育不良。另一种是潜伏期短(1-3年)，没有先天发育不良阶段，特征是在拓扑异构酶II抑制剂之后出现。染色体异常可确诊t-Leuk/MDS，并预示预后不良，尤其是涉及7号染色体得失的染色体异常。t-AML/MDS尚无标准治疗方法。本文就t-AML/MDS的各种治疗方法作一综述。治疗可以是积极的，具有治疗意图，特别是对于那些没有因先前的恶性肿瘤或化疗而导致终末器官损害的年轻患者。已经设计了各种化疗方案来克服化疗耐药，这通常是这些综合征的特征。骨髓移植提供了最好的治愈机会，清髓性和非清髓性方案都已设计好。对于无法承受传统治疗方案的患者来说，低剂量化疗是一种选择，而对于年老或虚弱的患者来说，支持性护理是一种合法的选择。考虑到患者的年龄、疾病状况和风险因素，迫切需要进行多中心研究，以提供明确的治疗指南所依据的数据。
Abstract Therapy-related leukemia and therapy-related myelodysplasia (t-AML/MDS) are serious and increasingly frequent complications of cytotoxic chemotherapy and/or radiotherapy. Two syndromes can be distinguished, one of which has a long latency (5-7 years or more) and is seen following alkylating agents, frequently with an antecedent dysplastic phase. The other has a short latency period (1-3 years), no antecedent dysplastic phase, and is characteristically seen following topoisomerase II inhibitors. Chromosomal abnormalities can confirm t-leuk/MDS and are predictive of poor prognosis, particularly those involving gains and losses of chromosome 7. There is no standard therapy for t-AML/MDS. This review concentrates on the various treatment approaches for t-AML/MDS. Treatment can be aggressive, with curative intent, particularly for patients who are young with no end-organ damage from the prior malignancy or chemotherapy. Various chemotherapy regimens have been designed to overcome the chemoresistance which is generally characteristic of these syndromes. Bone marrow transplantation offers the best chance for cure, and both myeloablative and nonmyeloablative protocols have been designed. Low dose chemotherapy is an option for patients not able to withstand traditional curative regimens and supportive care is a legitimate option for elderly or infirm patients. Multicenter studies are urgently needed to provide data on which clearcut treatment guidelines can be based, taking into account the patient's age, disease status and risk factors.
登录
查看更多内容
影响因子：
20.3
作者：
J. Rowley;H. Golomb;J. Vardiman
通讯作者：
J. Rowley;H. Golomb;J. Vardiman
治疗相关急性非淋巴细胞白血病患者外周血淋巴细胞中 O6-烷基鸟嘌呤 DNA 烷基转移酶活性低。
影响因子：
11.2
作者：
Sagher,D;Karrison,T;Schwartz,JL;Larson,R;Meier,P;Strauss,B
通讯作者：
Strauss,B
同种异体骨髓移植治疗继发性白血病或骨髓增生异常。
影响因子：
10.1
作者：
Witherspoon,RP;Deeg,HJ
通讯作者：
Deeg,HJ
乳腺癌患者米托乳醇治疗继发的骨髓增生异常综合征和急性非淋巴细胞白血病。
DOI：
10.1200/jco.1989.7.9.1252
发表时间：
1989
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
--
作者：
Falkson,G;Gelman,RS;Dreicer,R;Tormey,DC;Alberts,AS;Coccia-Portugal,MA;Rushing,D;Bennett,JM
通讯作者：
Bennett,JM
影响因子：
45.3
作者：
Silverman, LR;Demakos, EP;Holland, JF
通讯作者：
Holland, JF