成人急性淋巴细胞白血病治疗进展

Treatment of adults with acute lymphoblastic leukemia

尽管应用各种不同的诱导缓解方案,80%-95%的成人急性淋巴细胞白血病(ALL)可获得形态学上的完全缓解,但大部分病人很快复发。能否获得免疫学或分子水平的微小残留病(MRD)状态及达到MRD的速度极为重要。缓解后治疗是病人长期生存的关键。接受异基因移植的病人复发率明显降低。但在年龄35-40岁以上的移植患者中,较高的移植相关死亡率抵消了异基因移植的生存优势。相配无关供体移植的应用日益广泛,可用于所有高危病人。降低强度的移植可能增加老年患者的生存率。伊马替尼甲磺酸的应用彻底改变了ph阳性ALL的治疗方法,特别是该型老年患者。诊断时有CNS累及的患者,只要给予及时治疗,对预后无明显不利影响。

80% - 95 % of adults with acute lymphoblastic leukemia（ALL） can achieve a morphological remission, irrespective of the induction regimen used;however, the majority of such patients relapse. Most crucial is the achievement of a state of minimal residual disease by immunological or molecular techniques and rapidity with which this is achieved. Postremission therapy is critical for the achievement of long - term disease - free survival. All patients who undergo an allogeneic transplant have a significantly lower relapse rate. However, among patients older than 35 or 40 years,the high treatment- related mortality has abrogated the overall survival advantage of an allogeneic transplanta- tion. Matched unrelated donor transplant is becoming increasingly used in ALL, and is progressively applied to all high - risk patients. Reduced - intensity transplantation has a potential of increasing the survival among older patients. Imatinib mesylate has altered the standard of care for Ph -positive ALL, especially among older patients with this ge- netic abnormality. There is no evidence that patients with CNS disease at presentation do worse than other patients, comparable for other risk factors,provided that the initial CNS involvement is promptly treated.