伴骨髓增生异常相关改变的急性髓系白血病治疗研究进展

Review of Treatment for Acute Myeloid Leukemia with Myelodysplasia-related Changes

伴骨髓增生异常相关改变的急性髓系白血病(acute myeloid leukemia with myelodysplasia-related changes,AML-MRC)是2008年世界卫生组织正式命名的急性髓系白血病的一种独特亚型,占所有AML-MRC的25%~34%,与非AML-MRC相比,其预后更差。AML-MRC患者多见于老年人,常有严重贫血症状,对传统化疗不耐受且缓解率很低,因此针对AML-MRC的治疗一直是国际公认的难题。随着DNA芯片、二代测序等技术的广泛应用,AML-MRC的遗传学本质不断被发现,对其个性化治疗也在不断发展。目前除了化疗及造血干细胞移植外,一些新兴的治疗方案如脐血干细胞移植、免疫治疗及靶向治疗等不断在AML-MRC中应用,且取得了较好的临床疗效,但仍有许多不足需要进一步研究。本文的主要目的是讨论各治疗方案对AML-MRC的临床疗效,总结各新型治疗方案及相关临床试验在AML-MRC中的应用,并探索对其治疗潜在的发展方向。

Acute myeloid leukemia with myelodysplasia-related changes(AML-MRC)is an unique subtype of acute myeloid leukemia which officially named by the World Health Organization in 2008,accounting for 25%-34%,and has a worse prognosis than non-AML-MRC.AML-MRC patients are more common in elderly with severe anemia and intolerant to conventional chemotherapy with low remission rate.Therefore,the treatment of AML-MRC has been an internationally recognized problem for a long time.With the widespread application of DNA chip,next-generation sequencing and other technologies,the genetic essence of AML-MRC has been continuously discovered and the personalized treatment has also been developed.Currently,in addition to chemotherapy and hematopoietic stem cell transplantation,other emerging treatments such as cord blood transplantation,immunotherapy and targeted therapy are constantly been applied in AML-MRC patients which obtain well clinical effects,but there are still many deficiencies needing to be further studied.The main purpose of this article was to discuss the clinical efficacy of different treatment for AML-MRC,summarized the application of different new therapies and related clinical trials,and discussed the potential development direction of treatment for AML-MRC.