不适合大剂量化疗和造血干细胞移植的急性淋巴细胞白血病患者的治疗

N. Govedarović
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摘要

介绍。急性淋巴细胞白血病是一种以前体b细胞、t细胞或较少的nk细胞前体增殖为特征的恶性疾病。b细胞急性淋巴细胞白血病在>60岁的患者中比在60岁的患者中比在<60岁的患者中更常见(89%比66%),细胞遗传学异常如t(9;22)在老年人中比在年轻人中更常见(36%比19%)。治疗。老年人和有合并症的患者需要较少的强化治疗,以皮质类固醇、长春新碱和天冬酰胺酶为基础,同时避免蒽环类药物和烷基化剂,因为与治疗相关的死亡率很高。对不?ph阳性急性淋巴细胞白血病患者,推荐酪氨酸激酶抑制剂联合低强度化疗或单独使用皮质类固醇。对于t(9;22)阴性患者,建议低剂量皮质类固醇化疗联合或不联合免疫治疗。对于t细胞急性淋巴细胞白血病患者,使用venetoclax进行化疗可能是一种选择。结论。靶向治疗的引入改变了急性淋巴细胞白血病的治疗选择。对于老年患者,靶向治疗是一种必要的治疗方式,因为标准化疗因其毒性和无效而导致预后不良。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Treatment of patients with acute lymphoblastic leukemia who are not suitable for high-dose chemotherapy and hematopoietic stem cell transplantation
Introduction. Acute lymphoblastic leukemia is a malignant disease characterized by the proliferation of precursor B-cells, Tcells or less often, precursors of NK-cells. B-cell acute lymphoblastic leukemia is more common in patients >60 years of age compared to patients <60 years of age (89% vs. 66%), and cytogenetic abnormalities such as t(9;22) (Ph+) are more common in older than younger patients (36% against 19%). Elderly patients often have a poor status and comorbidities, so poor disease outcome is more common. Clinical and biological features. B cell acute lymphoblastic leukemia is more common in patients >60 years of age compared to patients <60 years of age (89% vs 66%) and cytogenetic abnormalities such as t(9;22) are more common in older vs. younger (36% vs. 19%). Therapy. The elderly and patients with comorbidities require less intensive therapy, based on corticosteroids, vincristine and asparaginase, while avoiding anthracyclines and alkylating agents, due to the high mortality associated with treatment. For ?unfit? patients with Ph-positive acute lymphoblastic leukemia, tyrosine kinase inhibitors with reduced-intensity chemotherapy or corticosteroids alone are recommended. For t(9;22) negative patients, low-dose corticosteroid chemotherapy with or without immunotherapy is recommended. For patients with T-cell acute lymphoblastic leukemia, chemotherapy with venetoclax may be an option. Conclusion. The introduction of targeted therapy has changed treatment options in acute lymphoblastic leukemia. For elderly patients, targeted therapy is a necessary modality since standard chemotherapy leads to a poor outcome due to its toxicity and ineffectiveness.
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