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Ph染色体阴性成人急性淋巴细胞白血病的缓解后治疗

Author
Richard A Larson, MD
Section Editor
Bob Lowenberg, MD, PhD
Deputy Editor
Rebecca F Connor, MD
Translators
颜晓菁, 教授

引言

80%以上新诊断的成人急性淋巴细胞白血病(acute lymphoblastic leukemia, ALL)患者在进行强化诱导化疗后可以获得完全缓解(complete remission, CR)。然而，如果不进行进一步细胞毒治疗，这些患者几乎都会在数周或数月内复发。相反，标危的成人患者如进行缓解后治疗，预期5年生存率最高可达60%。

诱导治疗旨在减少体内白血病细胞总数，使其从接近1012降至细胞学检测不到的水平以下，即大约109以下。然而，一般认为首次获得临床和形态学CR的患者仍有检测不到的较大的白血病细胞负荷[即“微小残留病”(minimal residual disease, MRD)]，如果不进一步治疗的话，这些白血病细胞会导致疾病在数周或数月内复发。

缓解后治疗(如巩固治疗、强化治疗)的主要目的是根除这种MRD。缓解后治疗有3种基本选择(按强度由低到高排列)：巩固加维持化疗、自体造血干细胞移植(hematopoietic cell transplantation, HCT)、异基因HCT。对个体患者而言，以上方案的选择取决于诸多因素，包括：

●单纯巩固化疗的预计复发率(受患者特征和肿瘤特征的强烈影响)

●治疗方案相关的预计并发症发病率和死亡率(取决于患者特征，如年龄和共存疾病)

                  

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Literature review current through: 2017-06 . | This topic last updated: 2015-11-24.
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