老年急性髓性白血病的治疗现状

Current and emerging strategies for the management of acute myeloid leukemia in the elderly

急性髓性白血病(AML)占成人急性白血病近80%。35%新诊断的AML患者年龄≥75岁,诊断时的中位年龄67岁。老年AML患者比年轻个体对标准化疗反应差,完全缓解率和无复发生存率低。老年患者在AML之前常先出现骨髓增生异常综合征(MDS)和预后不良的核型如5q-或7q-更常见。在既往10年间新治疗的应用,其中最先出现的是吉姆单抗(gemtuzumab ozogamicin)。其他药物仍在试用和评估中,包括多药耐药抑制剂、法尼基转移酶抑制剂(FTI)、新的核苷类药物和FLT抑制剂等。

Acute myeloid leukemia（AML） accounts for approximately 80% of acute leukemias diagnosed in adults.As 35% of newly diagnosed patients are aged≥75 and the median age at diagnosis is 67.Elderly individuals also respond less well to standard chemotherapy than do younger individuals,as reflected by lower complete remission and relapse-free survival rates in major clinical trials.Compared with AML in younger individuals,AML in the elderly more often emerges from a preceding myelodysplastic syndrome and is more frequently associated with poor prognosis karyotypes such as 5q-or 7q-.The introduction of novel therapies over the past decade has already altered the treatment paradigm of elderly individuals with AML.The first of these to emerge was gemtuzumab ozogamicin.Other agents are currently under evaluation in clinical trials,including inhibitors of multidrug resistance,farnesyltransferase inhibitors,novel nucleoside analogues,and inhibitors of the FMS-like tyrosine kinase-3.