儿童急性B淋巴细胞白血病的优化治疗

Optimized treatment of childhood B-lineage acute lymphoblastic leukemia

摘要:

儿童急性淋巴细胞白血病约占整体儿童白血病的75%，其中，急性B淋巴细胞白血病占儿童急性淋巴细胞白血病的80%以上。半个世纪以来，利用新技术不断发现新的分子生物靶标并用于精准的疾病预后分层，儿童急性淋巴细胞白血病的5年总生存率逐年提高。随着对远期生活质量的关注日益增强，儿童急性B淋巴细胞白血病的治疗从诱导治疗到维持治疗强度在不断优化，包括髓外白血病治疗去除放疗也有尝试，并获得成功。优化治疗的实现也得益于免疫学、分子生物学相关新技术的发展、规范化临床队列及与之相应的生物样本库建立。该文对近年来精准分层的实施及急性B淋巴细胞白血病降低强度优化治疗的相关研究进行梳理总结，为临床医生提供参考。

Abstract:

Childhood acute lymphoblastic leukemia (ALL) accounts for about 75% of childhood leukemia cases, and B-lineage acute lymphoblastic leukemia (B-ALL) accounts for more than 80% of childhood ALL cases. Over the past half century, new molecular biological targets discovered by new techniques have been used in precise stratification of disease prognosis, and there has been a gradual increase in the 5-year overall survival rate of childhood ALL. With the increasing attention to long-term quality of life, the treatment of childhood B-ALL has been constantly optimized from induction therapy to the intensity of maintenance therapy, including the treatment of extramedullary leukemia without radiotherapy, which has been tried with successful results. The realization of optimized treatment also benefits from the development of new techniques associated with immunology and molecular biology and the establishment of standardized clinical cohorts and corresponding biobanks. This article summarizes the relevant research on the implementation of precise stratification and the intensity reduction and optimization treatment of B-ALL in recent years, providing reference for clinicians.