Acute Lymphoblastic Leukemia, Version 2.2015

作者:Alvarnas Joseph C*; Brown Patrick A; Aoun Patricia; Ballen Karen Kuhn; Barta Stefan K; Borate Uma; Boyer Michael W; Burke Patrick W; Cassaday Ryan; Castro Januario E; Coccia Peter F; Coutre Steven E; Damon Lloyd E; DeAngelo Daniel J; Douer Dan; Frankfurt Olga; Greer John P; Johnson Robert A; Kantarjian Hagop M; Klisovic Rebecca B; Kupfer Gary; Litzow Mark; Liu Arthur; Rao Arati V; Shah Bijal; Uy Geoffrey L; Wang Eunice S; Zelenetz Andrew D
来源:Journal of the National Comprehensive Cancer Network, 2015, 13(10): 1240-1279.
DOI:10.6004/jnccn.2015.0153

摘要

Treatment of acute lymphoblastic leukemia (ALL) continues to advance, as evidenced by the improved risk stratification of patients and development of newer treatment options. Identification of ALL subtypes based on immunophenotyping and cytogenetic and molecular markers has resulted in the inclusion of Philadelphia-like ALL and early T-cell precursor ALL as subtypes that affect prognosis. Identification of Ikaros mutations has also emerged as a prognostic factor. In addition to improved prognostication, treatment options for patients with ALL have expanded, particularly with regard to relapsed/refractory ALL. Continued development of second-generation tyrosine kinase inhibitors and the emergence of immunotherapy, including blinatumomab and chimeric antigen receptor T-cell therapy, have improved survival. Furthermore, incorporation of minimal residual disease (MRD) monitoring has shown insight into patient outcomes and may lead to treatment modification or alternative treatment strategies in select populations. This excerpt focuses on the sections of the ALL guidelines specific to clinical presentation and diagnosis, treatment of relapsed/refractory ALL, and incorporation of MRD monitoring. To view the most recent complete version of these guidelines, visit NCCN.org.