对患有急性淋巴细胞白血病的青少年和年轻成年人进行儿科启发的治疗方案和HSCT:系统性审查
Yuliia Sereda1, Htun Ja Mai1, Ghid Kanaan1
1Brown University's School of Public Health, Providence, Rhode Island, United States.
Blood advances
|January 29, 2026
概括
儿科治疗方案改善了急性淋巴细胞白血病 (ALL) 的青少年和年轻成年人的生存率并降低了死亡率. 全基性造血干细胞移植 (HSCT) 可能导致更糟糕的结果,强调需要更多的研究.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
- 临床实践指南 临床实践指南
背景情况:
- 在青少年和年轻人 (AYA) 中急性淋巴细胞白血病 (ALL) 的最佳前线治疗仍然不确定.
- 目前比较不同治疗方法的证据有限,因此需要进行系统审查,以告知临床实践指南.
研究的目的:
- 系统地审查和元分析基于阿斯巴拉金酶 ("儿科") 与非阿斯巴拉金酶 ("成人") 治疗方案的证据.
- 评估全源造血干细胞移植 (HSCT) 与没有HSCT的有效性和安全性,用于在首次完全缓解 (CR) 阶段患有ALL的AYA.
主要方法:
- 在PubMed,CINAHL和PsycINFO的系统文献搜索到2023年11月29日.
- 包括19项研究比较治疗方案 (N=3,607) 和7项研究比较HSCT (N=7,492) 在AYA (15-39年).
- 对生存,缓解,毒性和生活质量结果的元分析,评估由于研究质量和有限的随机对照试验 (RCT) 的证据确定性.
主要成果:
- 儿科治疗方案与改善的5年整体存活率 (OS),无事件存活率 (EFS) 和无疾病存活率 (DFS) 相关,以及较低的治疗相关死亡率 (TRM).
- 异构性HSCT与较低的5年OS和DFS有关,但较高的非复发死亡率和TRM.
- 证据质量普遍较低,对毒性和特定亚组的数据有限,如Ph阴性ALL.
结论:
- 与"成人"疗法相比,基于阿斯巴拉金酶的"儿科"疗法可能为ALL的AYA提供生存益处.
- 异构性HSCT可能与第一CR中ALL的AYA中较差的生存结果有关.
- 高质量的研究,包括RCT和详细的子分析,对于确定ALL的AYA的最终治疗建议至关重要.
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