急性リンパ性白血病
Florent Malard1, Mohamad Mohty1
1Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France; Sorbonne University, INSERM, Saint-Antoine Research Centre, Paris, France.
Lancet (London, England)
|April 6, 2020
まとめ
急性リンパ性白血病 (ALL) は子供と成人に影響し,遺伝的変化が予後に影響します. リスクの階層化と免疫療法の進歩により 治療の成果が向上する見込みです
科学分野:
- 血液学
- 腫瘍学
- 遺伝学
背景:
- 急性リンパ性白血病 (ALL) は,リンパ前駆体細胞の遺伝的変異によって特徴づけられる,子供および成人の一般的な癌です.
- 予後要因は稀ですが,染色体異常や遺伝的変異はALLの主要な予後指標です.
- 現行の治療法では若年患者の治療結果が改善されますが,高齢者や再発または耐性疾患の患者は予後不良です.
研究 の 目的:
- 急性リンパ性白血病 (ALL) の病原性,予後,および治療に関する現在の理解を要約します.
- 遺伝的要因とリスクの階層化が ALL の結果に与える影響を強調する.
- ALL治療の新たな免疫療法戦略について議論する.
主な方法:
- 急性リンパ性白血病 (ALL) の疫学,遺伝学,治療結果に関する既存の文献のレビュー.
- 染色体異常や遺伝子変異を含む予後要因の分析
- 化学療法と免疫療法を含む現在の治療方法と新しい治療法の検討
主要な成果:
- ALLの発生率は1歳から4歳の間でピークに達し,遺伝的変異は細胞の分化と増殖に不可欠です.
- リスクの階層化と強化された化学療法により,特に小児および若年成人ALLの治療結果が改善されました.
- 高齢者および再発性/耐性ALLの患者のアウトカムは依然として困難です.
結論:
- 遺伝的変異はALLの発症と予後において中心的であり,リスクの階層化と治療の強さを指し示している.
- 化学療法により治療結果が改善されていますが CAR T細胞やモノクローナル抗体は ALL治療の未来です
- 全てのALL患者グループ,特に高齢者および耐性疾患患者の生存率を改善するために,免疫療法戦略に関するさらなる研究が不可欠です.
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