难治性白血病诊治进展

Progress on the diagnosis and treatment of refractory leukemia

难治性白血病因其本身特性难达完全缓解和长期无病生存，始终是恶性血液病领域研究的热点和难点，国内外关于难治性白血病的诊断标准在不断调整，引起白血病难治高危的因素也在不断的被发现；新的分子标志，基因突变或某些基因高表达，如FLT3跨膜区内部串联重复等，这些分子标志将决定急性白血病患者的预后。治疗难治性或复发性急性髓细胞性白血病仍然具有挑战性。多种新药正在开发和临床试验。临床许多新的治疗方法正在探讨。如应用耐药逆转剂、加强分子靶向治疗、改进造血干细胞移植和开发新药、组成新的化疗方案等；单克隆抗体和多肽疫苗与白血病相关抗原为治愈急性白血病带来了希望。

It is difficult for the patients of refractory leukemia to complete remission （CR） and long-term disease-free survival （DFS）, and it was always been the hot spots of research in the field of hematologic malignancies. The diagnostic criteria of refractory leukemia were adjusted constantly at domestic and foreign, the high-risk factors about refractory leukemia were found constantly too. New molecular markers that represent mutations or gene overexpression have been identified such as FMS-like tyrosine kinase-3 and nucleophosmin, which will enhance the ability to more aecuralely prognosticate for patients with acute myeloid leukemia. The treatment of patients with refractory or relapsed aeute myeloid leukemia remains challenging. Multiple new agents with tremendous potential were in development and clinical trials. Such as applying resistance reversal agents, enhancing molecular targeted therapy, improving the technology of hematopoietie stem cell transplantation, empoldering the new drugs, and forming a new chemotherapy program etc. Monoclonal antibodies and peptide vaccination with leukemia-associated antigens also brought the hopes of increasing the remission and cure rates for patients with acute myeloid leukemia.