儿童急性淋巴细胞白血病复发的研究进展.pdf

中华临床医师杂志( 电子版)2014 年9 月第8 卷第18 期 Chin J Clinicians(Electronic Edition),September 15,2014,Vol.8,No.18 ·3359 · ·综述· 儿童急性淋巴细胞白血病复发的研究进展 阮永胜 吴学东 【摘要】 儿童急性淋巴细胞白血病（ALL ）的治愈率不断提升，而复发成为ALL 诊疗的瓶颈。 本文从发病机理、危险分层、治疗进展三方面回顾分析了近十年关于儿童急性淋巴细胞白血病复发 的文献。发现部分基因组异常和耐药性相关，成为ALL 复发的主要原因之一。早期复发较晚期复发 预后要差，且检测微小残留白血病对复发有独立预测作用。治疗手段从化疗和造血干细胞移植发展 到分子靶向治疗、细胞治疗和免疫治疗新的层次。所以，正确认识ALL 复发的发病机理、依据危险 程度分层次进行综合治疗是ALL 复发目前诊疗的趋势。 【关键词】 急性淋巴细胞白血病； 复发； 儿童 Research progress in relapsed childhood acute lymphoblastic leukemia Ruan Yongsheng, Wu Xuedong. Departm ent of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China Corresponding author: Wu Xuedong, Email : xuedongwu@163. com 【Abstract 】 Although most children with acute lymphoblastic leukemia (ALL) are cured, certain subsets have a high risk of relapse. Treating relapsed ALL has become increasingly challenging. This paper retrospectively analyzed recent ten years studies about biological mechanisms, risk stratification and treatment with relapsed childhood ALL. There is a positive correlation between the abnormal genome and drug resistance. The prognosis of early relapsed is worse than lately relapsed. Meanwhile, minimum residual disease measurement is an independent prognostic factor for relapsed ALL. Other than traditional chemotherapy and hematopoietic stem cell transplantation, molecularly targeted therapies, cell therapies and immunotherapies have a rapid development nowadays. Thus it is a new trend that improved biological understanding of mechanisms of relapse and risk-adjusted comprehensive therapy. 【Key words 】 Acute lymphoblastic leukemia; Relapse; Child 近十年来，随着依据危险度分层次化疗和支持 一、发病机制 治疗的不断改善，发达国家对儿童急性淋巴细胞白 1. 基因组缺陷可能是发生耐药的基础：ALL 血病（acute lymphob