Treatment of fludarabine‐refractory chronic lymphocytic leukemia
Treatment of fludarabine‐refractory chronic lymphocytic leukemia
复制标题
氟达拉滨治疗难治性慢性淋巴细胞白血病
作者：
A. Tsimberidou;M. Keating
对嘌呤类似物的耐药性的发展定义了慢性淋巴细胞白血病(CLL)患者的一个低风险亚群。尽管近年来，化疗免疫联合治疗如氟达拉滨、环磷酰胺和利妥昔单抗在未经治疗的患者中诱导了95%的有效率，并增加了无失败存活率，但许多患者由于缺乏疾病反应或对氟达拉滨出现耐药而无法治愈。氟达拉滨难治性疾病被定义为对氟达拉滨无效或在含氟达拉滨的治疗方案治疗6个月内复发的慢性淋巴细胞性白血病。这种疾病的自然病程与生存不良有关。挽救治疗的策略包括含有阿伦图珠单抗的方案、靶向药物和异基因干细胞移植。单药阿仑珠单抗对40%的氟达拉滨耐药的CLL患者有反应，但反应不持久，中位生存期约为1至2年。Alemtuzumab还与氟达拉滨、环磷酰胺和/或利妥昔单抗以及其他药物，如来那度胺和黄烷醇以及靶向药物联合使用，用于氟达拉滨耐药的CLL。累积的证据表明，对于对氟达拉滨无效或在嘌呤类似物治疗后12个月内出现疾病复发的患者，异基因干细胞移植是一种有效的治疗策略。总之，包括阿仑珠单抗和/或利妥昔单抗和异基因干细胞移植在内的化疗免疫疗法改善了该病的预后，但仍需要新的、更有效的治疗方法。癌症2009年。©2009美国癌症协会。
The development of resistance to purine analogs defines a poor‐risk subset of patients with chronic lymphocytic leukemia (CLL). Although in recent years chemoimmunotherapeutic combinations such as fludarabine, cyclophosphamide, and rituximab have induced response rates of 95% in previously untreated patients and increased the rates of failure‐free survival, CLL remains incurable for many patients because of a lack of disease response or the development of refractoriness to fludarabine. Fludarabine‐refractory disease is defined as CLL that does not respond to fludarabine or that recurs within 6 months of treatment with a fludarabine‐containing regimen. The natural course of the disease is associated with poor survival. Salvage therapeutic strategies include alemtuzumab‐containing regimens, targeted agents, and allogeneic stem cell transplantation. Single‐agent alemtuzumab induces response in up to 40% of patients with fludarabine‐refractory CLL, but responses are not durable, and the median survival is approximately 1 to 2 years. Alemtuzumab is also combined with fludarabine, cyclophosphamide, and/or rituximab, and other agents such as lenalidomide and flavopiridol, as well as targeted agents, and used in fludarabine‐refractory CLL. Cumulative evidence suggests that allogeneic stem cell transplantation is an efficacious therapeutic strategy for patients who do not respond to fludarabine or who develop disease recurrence within 12 months after purine analog treatment. In conclusion, chemoimmunotherapy regimens that include alemtuzumab and/or rituximab and allogeneic stem cell transplantation improve the prognosis of this disease, but there is a continued need for novel, more effective therapies. Cancer 2009. © 2009 American Cancer Society.
登录
查看更多内容
影响因子：
158.5
作者：
Rai, KR;Peterson, BL;Schiffer, CA
通讯作者：
Schiffer, CA
影响因子：
20.3
作者：
Byrd, John C.;Lin, Thomas S.;Grever, Michael R.
通讯作者：
Grever, Michael R.
影响因子：
158.5
作者：
Rassenti, LZ;Huynh, L;Kipps, TJ
通讯作者：
Kipps, TJ
影响因子：
45.3
作者：
Flinn, Ian W.;Neuberg, Donna S.;Tallman, Martin S.
通讯作者：
Tallman, Martin S.
影响因子：
45.3
作者：
Grever, Michael R.;Lucas, David M.;Byrd, John C.
通讯作者：
Byrd, John C.