Ph阴性成人ALL的治疗.pptVIP

. GMALL 07/2003和06/99：MRD指导干预【分子学缓解失败（16周）患者Allo-SCT显著提高生存】 未行Allo-SCT者，5年维持CR和生存比例仅12%和33% 早期巩固治疗结束时（16周）分子学缓解失败的患者，MRD＞104者仅有12%患者维持CR,中位复发时间7.6个月（A）； MRD＞103者仅有3%患者维持CR,中位复发时间4.9个月（B） GMALL的治疗选择和干预模式-以传统预后因素结合动态MRD监测为基础 成人ALL未来的诊断治疗？ 诊断和预后判断更强调遗传学资料(尤其是基因组学资料) 在治疗早期贯彻分层治疗的理念，真正做到分层治疗 根据MRD监测，动态的危险度分组 Allo-SCT的地位将得到进一步细化，如何提高ABMT适应症的选择和疗效值得进一步探讨 新药、单克隆抗体和靶向治疗的应用。 热爱生活 享受工作宽容他人 善待自己  Thanks! Slides 33 34: Among young patients with ALL, for whom conventional chemotherapy has a high success rate, allogeneic HCT is generally reserved for those with high risk disease (high leukocyte count at diagnosis, presence of poor risk cytogenetic markers), those failing to achieve remission or relapsing after chemotherapy. Among 1,654 patients 20 years of age receiving HLA-identical sibling HCT, 3-year probabilities of survival were 60% ± 2.5%, 52% ± 2% and 29% ± 4% for patients with early, intermediate and advanced disease, respectively. Corresponding probabilities among 1,941 recipients of unrelated donor HCT were 48% ± 3%, 39% ± 1.5% and 17% ± 3%. * Slides 35 36: Older age at onset is itself a high risk feature in ALL. Consequently, a larger proportion of ALL patients older than 20 years undergo allogeneic HCT for early disease. Among 1,564 patients 20 years of age receiving HLA-identical sibling HCT, 3-year probabilities of survival were 47% ± 2%, 34% ± 3% and 17% ± 2% for patients with early, intermediate and advanced disease, respectively. Corresponding probabilities among 1,291 recipients of unrelated donor HCT were 41% ± 2.5%, 29% ± 3% and 12% ± 2%. * * Br J Haematol, 2012, 157： 463–471 UKALLXII/ECOG2993结果 (老年人、年轻人方案一致) 老年患者的生存明显低于年轻患者！ (二) T-ALL T-ALL占儿童初诊ALL的10%-15%，成人ALL的20%-25%。 T-ALL的临床特点、免疫学、细胞遗传学、分子学和基因 特征均与B-ALL不同。 反复多疗程应用含足量DNR、L-ASP、HD-AraC、CTX、HD- MTX的方案，T-ALL可以取得和B-ALL同样的疗效。 GMALL经验：HD-Ara-C、大剂量或高分次CTX显著提高胸 腺T-ALL生存 GMALL Study 05/93 Induction V,P,D,A,C,AC,M,MP + HDAC/Mi in HR Consolidation S