PDF(Pubmed)
Abstract：
Treatment algorithms differ for adult patients with Philadelphia-negative (Ph-) and Philadelphia-positive (Ph+) acute lymphoblastic leukemia (ALL). For Ph- ALL intensive induction-consolidation chemotherapy using \"pediatric-inspired\" protocols is a standard of care. Allogeneic hematopoietic cell transplantation (allo-HCT) from either an HLA-matched sibling, unrelated or haploidentical donor should be considered for patients with high estimated risk of relapse. Inadequate response at the level of measurable residual disease (MRD) is the strongest adverse prognostic factor. Patients with B-ALL and detectable MRD should be treated with blinatumomab. In the future, the use of blinatumomab and/or inotuzumab ozogamycin in addition to first-line chemotherapy may become a new standard of care reducing the role of allo-HCT. For patients with Ph+ ALL, tyrosine kinase inhibitors (TKI) are the most important components of treatment protocols, while the intensity of chemotherapy may be reduced. Allo-HCT is recommended for all patients treated with imatinib along with low-intensity chemotherapy. Results of phase-II studies using front-line dasatinib or ponatinib in sequence or in combination with blinatumomab are very promising. Such a strategy may allow the avoidance of systemic chemotherapy. The future role of allo-HCT in this context appears uncertain.
摘要：
对于费城阴性（Ph-）和费城阳性（Ph）急性淋巴细胞白血病（ALL）的成年患者，治疗算法有所不同。对于Ph-ALL，使用“儿科启发”方案的强化诱导巩固化疗是一种标准护理。来自HLA匹配的同胞的异基因造血细胞移植（allo-HCT），对于估计复发风险较高的患者,应考虑无关或单倍体供体.在可测量的残留疾病（MRD）水平上的反应不足是最强的不良预后因素。B-ALL和可检测的MRD患者应使用blinatumomab治疗。在未来,在一线化疗的基础上,使用博纳单抗和/或伊妥珠单抗奥唑霉素可能成为降低allo-HCT作用的新标准.对于Ph+ALL患者，酪氨酸激酶抑制剂（TKI）是治疗方案中最重要的组成部分，而化疗的强度可能会降低。Allo-HCT被推荐用于所有接受伊马替尼和低强度化疗的患者。使用一线dasatinib或ponatinib顺序或与blinatumomab联合使用的II期研究结果非常有希望。这样的策略可以允许避免全身化疗。在这种情况下，allo-HCT的未来作用似乎不确定。
