编者按：老年急性淋巴细胞白血病（ALL）是临床不容忽视的群体，具有高Ph（+）、高甲基化、高发分子学异常等特点，临床治疗手段较成人和儿童患者少得多。酪氨酸激酶抑制剂的出现大大改变了Ph（+）ALL患者的治疗现状，其与其他手段联合使用有望进一步提高老年ALL患者的完全缓解率和总体生存。然而老年患者其体质原因在治疗过程中因对药物耐受能力差，具有一定的治疗风险，如何平衡风险和受益仍有待我们进一步临床研究。在本届ASCO年会上英国布里斯托尔大学医院David I. Marks教授就此问题进行了专题报告。会后，《肿瘤瞭望》有幸采访了Marks教授。

 

　　Oncology Frontier: Allotransplant for older patients with acute lymphoblastic leukemia: does it work?

　　《肿瘤瞭望》：异基因干细胞移植对老年ALL患者是否有效？

 

　　Dr Marks: Within our new UKALL XIV study (which is our major study from the age of 25 to 65)， reduced intensity allografting has a big role. Because of the very poor outcomes in older patients in our previous study， UKALL XII/ECOG E2993， where there was only 15% long-term survival， we are prospectively studying reduced intensity allografting. To be eligible for this， they have to be over the age of 40 and they have to have a sibling donor or a well-matched unrelated donor. We have some preliminary data in about 80 patients and it is looking very promising. We need much longer follow-ups to determine relapse rates， but so far， I can say that the transplant-related mortality in this group is about 15%， which is reasonable， and early survival looks promising. In this setting we are using fludarabine， melphalan and alemtuzumab (an in-vivo T-cell depleted strategy)， we may see an excess of relapse. We are starting to see some relapses and we need much longer follow-ups to know if it will be successful.

　　Marks教授：我们正在进行一项新的研究（主要目标人群年龄25~65岁），在这项研究中减低强度的异基因移植效果非常好。根据我们既往的研究结果显示，老年患者的治疗结果非常差，仅有15%长期生存，因此我们正在尝试减低强度异基因移植，并观察其作用。研究纳入年龄大于40岁的患者，需有同胞供者或匹配良好的无关供者。目前已获得近80例患者的初步数据，初步看来具有一定的治疗前景，但仍需要更长的随访以明确复发。

 

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