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: Can you discuss factors affecting therapeutic decisions for older patients with acute lymphoblastic leukemia (ALL)?

　　《肿瘤瞭望》：请您谈谈有哪些因素影响老年ALL患者治疗预后？

 

　　Dr Marks: It’s a complex question and our group believes this older age group hasn’t been systematically studied so we are conducting a trial that addresses this issue， the UKALL 60+ trial. What we are aiming to do is understand the factors that make physicians choose different treatment intensities. Particularly， we are looking at performance status but also comorbidities using validated tools from the National Health Service. I think the subtype of ALL is very important. About a third of these patients have Philadelphia-positive ALL and they need tyrosine kinase inhibitors and deintensifying chemotherapy regimen. Management of Philadelphia-negative disease is more problematic. It is about working out a safe backbone to use and then look at novel agents on top of that backbone. We are hoping to recruit 150 older patients in this study and will be involving other countries as well as the UK. We have a primary endpoint of one-year event-free survival. We think if we can get people into remission and safely through to one year， then we can think about potentially curative strategies. Right now though， we don’t have the data. We have recruited 50 patients to the study and we are learning as we go along. There has been some significant morbidity and even some mortality so far， but of the patients who have gone through the induction cycle， the complete remission rate is actually pretty good.

　　Marks教授：这是很复杂的一个问题。目前针对老年ALL患者的治疗缺少系统研究，因此，我们现在正在进行一项UKALL 60的临床试验就是关于上述主题的。我们希望通过研究明确哪些因素影响临床医生选择不同强度的治疗方案。我个人认为ALL的亚分类很重要。大约三分之一的患者为Ph(+)ALL，这些患者需给予酪氨酸激酶抑制剂和较温和的化疗方案治疗；相比之下Ph(-)ALL的处理存在问题较多，应在安全的基本方案上加用新的治疗药物。

 

　　在UKALL60多中心的临床试验中，我们计划招募150名老年患者，分别来自英国以及其他国家。我们研究的主要终点是1年无事件生存，因为如果患者能够获得缓解并全安生存1年，那他很有可能进行治愈性治疗。

 

　　目前我们已经招募了50名患者，还没有拿到相关数据，我们也在实践中总结不断总结，虽然部分患者已出现一些明显的并发症甚至死亡，但如果患者能顺利度过诱导化疗期，患者的完全缓解率还是非常不错的。

 

[1]  [2]  [3]  下一页

评论发言