急性白血病2014.ppt

初诊2628ALL儿童EFS(A) 和OS (B) 1962-2005年，St. Jude Children’s Research Hospital的15连续的研究 Pui CH and Evans W. N Engl J Med 2006; 354:166-178 儿童ALL疗效逐步提高 年龄分层治疗结果(6 CALGB studies on 1059 adults with ALL, 1988-2007) 15% 59% 39% Ben Sanford (CALGB), 2008; unpublished Adult ALL: Large Clinical Trials Clinical Trials N Age Treatment CR, % DFS, % Study Years GMALL 02/84 562 28 BFM 75 39 84-90 GMALL 05/93 1163 35 BFM, HD-ARA-C, HD-MTX 87 35-40 93-99 CALGB 8811 198 35 BFM, ↑ Cy, ↑ ASP 85 36 88-91 CALGB 19802 163 41 BFM, ↑ Cy , ↑ DNR 78 35 99-01 GIMEMA 778 28 BFM ± Cy 82 29 88-94 MRC-UKALL XA 618 15 BFM + early intensification 89 -- MRC/ECOG 1521 BFM + HD-MTX ± SCT 91 38 93-04 UCSF 8707 84 27 BFM intensified 93 52 87-98 Hyper-CVAD 288 40 Cy, D, AD, HD-MTX, HD-ARA-C 92 38 92-00 Survival in ALL Has Improved in All Age Groups Except the Oldest Patients This research was originally published in Blood. Pulte D, et al. Blood. 2009;113:1408-1411. ? the American Society of Hematology *Point estimates. 5-Yr Relative Survival* Age Range,% ± SE 1980-1984 2000-2004 Increase, % P Value 15-29 yrs 33.7 ± 3.5 53.6 ± 3.2 19.9 .0001 30-44 yrs 20.2 ± 4.8 34.3 ± 3.9 14.1 .002 45-59 yrs 10.3 ± 4.9 24.3 ± 3.4 14.0 .0002 60 yrs 8.4 ± 3.4 12.7 ± 2.9 4.3 .48 展望 分型诊断进一步精细：根据基因芯片研究结果，寻找特异性分子标记 完善细胞毒化疗和HSCT治疗策略 寻找多种新的靶向药物 开拓肿瘤疫苗治疗 完善MRD的检测方法 建立有序的综合治疗模式 个体化治疗 基因 分化 凋亡 增殖 诱导分化 诱导凋亡 化疗放疗 免疫疗法 基因疗法 靶向疗法 Lifetime risk: 罹患风险 * * * Slide * This line graph of SEER data(美国肿瘤登记数据库) from 2000–2003 shows the rate of ALL per million per year according to age at diagnosis. During this time period, the median age of patients with ALL was 13 years.1,2 Most patients (61.1%) were 20 years of age. The total percentage of patients aged 20 years or older at diagnosis was 38.9%. The median age of patients with adult ALL (≥ 20 years of age) is 64 years. References: SEER Stat Fact Sheets. Acute Lymphocytic Leukemia. Available at: .statfacts. Accessed July 25, 2006. SEER Fast Facts