异基因造血干细胞移植是否仍是费城染色体阴性成年人急性淋巴细胞白血病第一次缓解后的首选治疗

Is allogeneic hematopoietic stem cell transplantation still the first-line therapy after the first remission in adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia？

异基因造血干细胞移植（allo-HSCT）是否仍是费城染色体阴性急性淋巴细胞白血病（Ph-ALL）成年患者首次完全缓解（CR1）后的首选治疗方案依然充满争议。最近的许多研究报道青少年和年轻成年 Ph-ALL 患者可能获益于儿童化疗方案。传统的基线危险因素并不能令人满意地预测预后，相反，早期微小残留病变（MRD）才是最佳分层工具，有助于为不同 MRD 状态的患者提供不同的治疗选择。新的治疗方法，如嵌合抗原受体（CAR）T 细胞和 blinatumomab 抗体，已经在难治、复发患者的治疗中显示出了较好的疗效。通过对儿童方案、MRD 驱动策略和新治疗方法的综合运用，可能有望改变将来治疗Ph-ALL 成年患者的模板，从而改善预后和减少不良反应。

Whether allogeneic hematopoietic stem cell transplantation （allo-HSCT） is the optimal treatment for adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia （Ph - ALL） after the first complete remission （CR1） or not is still a controversial issue. Many studies have recently reported that adolescents and young adults with Ph- ALL may benefit from pediatric chemotherapy. Conventional baseline risk factors cannot satisfactorily predict prognosis, conversely, the early minimal residual disease （MRD） is the best stratification tool to offer different treatments for patients with different MRD status. Novel therapies, such as CAR-T cells and blinatumomab, have shown promising results in relapsed/refractory patients. Through comprehensive application of pediatric chemotherapy protocols, MRD driven strategy and novel therapies, it is hopeful to change the paradigm of how to treat adults with Ph - ALL in the future, and to bring improved outcomes and decreased adverse events.