Improved Prognosis for Older Adolescents With Acute Lymphoblastic Leukemia
Improved Prognosis for Older Adolescents With Acute Lymphoblastic Leukemia
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DOI：
10.1200/jco.2010.32.0325
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发表时间：
2011-02-01
影响因子：
45.3
通讯作者：
Relling, Mary V.
中科院分区：
文献类型：
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作者：
Pui, Ching-Hon;Pei, Deqing;Relling, Mary V.
目的历史上，患有急性淋巴细胞白血病 (ALL) 的老年青少年和年轻人的预后比年轻患者的预后要差得多。我们回顾了四项连续全面治疗研究中接受治疗的老年青少年（15 至 18 岁）的结果，以确定最近改进的治疗是否扩展到了这一高危人群。 患者和方法 1991 年至 2007 年间，963 名儿科患者（包括 89 名老年青少年）参加了全面治疗研究 XIIIA、XIIIB、XIV 和 XV。在前三项研究中，治疗选择是基于临床特征和白血病细胞遗传学。在研究 XV 中，残余疾病水平被用来指导治疗，其特点是强化甲氨蝶呤、糖皮质激素、长春新碱和天冬酰胺酶，以及针对高风险 ALL 的早期三联鞘内治疗。结果 89 名年龄较大的青少年明显更有可能患有 T 细胞 ALL、t(4; 11)(MLL-AF4) 以及在缓解诱导期间或结束时可检测到的微小残余疾病；与年轻患者相比，他们患有 t(12; 21)(ETV6-RUNX1) 的可能性较小。在前三项研究中，44 名年龄较大的青少年的无事件生存率和总生存率明显低于 403 名年轻患者。研究 XV 消除了这种预后差距：45 名年龄较大的青少年的 5 年无事件生存率为 86.4% +/- 5.2%（标准误差），453 名年轻患者的 5 年无事件生存率为 87.4% +/- 1.7%；总生存率分别为 87.9% +/- 5.1% 和 94.1% +/- 1.2%。结论 大多数患有 ALL 的老年青少年可以通过风险调整的强化化疗治愈，无需干细胞移植。 J 临床肿瘤杂志 29：386-391。 (c) 2010 年美国临床肿瘤学会
PurposeThe prognosis for older adolescents and young adults with acute lymphoblastic leukemia (ALL) has been historically much worse than that for younger patients. We reviewed the outcome of older adolescents (age 15 to 18 years) treated in four consecutive Total Therapy studies to determine if recent improved treatment extended to this high-risk group.Patients and MethodsBetween 1991 and 2007, 963 pediatric patients, including 89 older adolescents, were enrolled on Total Therapy studies XIIIA, XIIIB, XIV, and XV. In the first three studies, treatment selection was based on presenting clinical features and leukemic cell genetics. In study XV, the level of residual disease was used to guide treatment, which featured intensive methotrexate, glucocorticoid, vincristine, and asparaginase, as well as early triple intrathecal therapy for higher-risk ALL.ResultsThe 89 older adolescents were significantly more likely to have T-cell ALL, the t(4; 11)(MLL-AF4), and detectable minimal residual disease during or at the end of remission induction; they were less likely to have the t(12; 21)(ETV6-RUNX1) compared with younger patients. In the first three studies, the 44 older adolescents had significantly poorer event-free survival and overall survival than the 403 younger patients. This gap in prognosis was abolished in study XV: event-free survival rates at 5 years were 86.4% +/- 5.2% (standard error) for the 45 older adolescents and 87.4% +/- 1.7% for the 453 younger patients; overall survival rates were 87.9% +/- 5.1% versus 94.1% +/- 1.2%, respectively.ConclusionMost older adolescents with ALL can be cured with risk-adjusted intensive chemotherapy without stem-cell transplantation. J Clin Oncol 29: 386-391. (c) 2010 by American Society of Clinical Oncology