慢性リンパ性白血病:臨床レビュー
Chadi Nabhan1, Steven T Rosen2
1Section of Hematology and Oncology, Department of Medicine, The University of Chicago Medicine, Chicago, Illinois.
JAMA
|December 3, 2014
まとめ
化学免疫療法は,慢性リンパ球性白血病 (CLL) の標準的な第一線治療法であり,最も一般的な成人白血病です. 治療は症状性疾患で開始され,高い生存率につながります.
科学分野:
- 血液学 ヘマトロジ
- 腫瘍学 腫瘍学
- 免疫学 免疫学とは
背景:
- 慢性リンパ球性白血病 (CLL) は,米国の成人の間で最も一般的な白血病です.
- CLLの診断は,毎年15,000人の個人に影響し,5,000人の死亡があります.
- 最近の進歩は,CLLの治療法を大幅に改善しました.
研究 の 目的:
- CLLの診断,ステージング,治療に関する根拠に基づいたレビューを提供するためです.
- CLL患者の現在の治療戦略とアウトカムを分析する.
主な方法:
- PubMed,Cochrane Library,Scopus,およびGoogle Scholarを使って,包括的な文献検索が行われました.
- 2000年から2014年の間に出版された24件のピアレビューされた記事は,事前に定義された基準に基づいて選択されました.
- 治療の推奨は,これらの選択された研究の分析から得られた.
主要な成果:
- 現在のステージングシステム (Rai,Binet) は,モノクローナルB細胞リンパ球症などの新しいCLL分類を完全にカバーしていません.
- リスクの階層化は,分子の分析と細胞遺伝学的分析を含み,異なるCLLサブセットを特定します.
- ファーストライン治療としての化学免疫療法は,75%から90%の応答率をもたらし,3年生存率は80%を超え,5年生存率は66%です.
結論:
- 化学免疫療法 (chemoimmunotherapy) は,症状のある慢性リンパ球性白血病の確立された標準的な第一線治療である.
- 症状の発症時に治療を開始すると,患者の生存率が著しく改善されます.
- 治療の進歩は,CLLと診断された成人のアウトカムを著しく改善しました.
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