ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Overview of the treatment for newly diagnosed Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia (ALL) in adults

Overview of the treatment for newly diagnosed Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia (ALL) in adults
Induction therapy
A BCR-ABL tyrosine kinase inhibitor (TKI) plus one of the following combination chemotherapy regimens:
  • Cancer and Leukemia Group B (CALGB study 8811 or 9111) ALL regimen[1,2]
  • Hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone (Hyper-CVAD) alternating with high-dose methotrexate and cytarabine[3]
  • French GRAALL-2003 regimen[4]
  • German GMALL protocols 06/99 and 7/03[5]

The combination of a TKI with or without a corticosteroid is capable of producing complete remissions in previously untreated Ph+ ALL with low toxicity[6]. This combination has not been directly compared with a TKI plus chemotherapy. If initial data are supported by subsequent studies, the combination of a TKI plus steroid may become an excellent option for patients, such as older adults, who are not able to tolerate combination chemotherapy.
Consolidation
Allogeneic hematopoietic cell transplantation in first complete remission is preferred. If the patient is not a candidate for transplantation, consolidation chemotherapy should be given that incorporates a BCR-ABL TKI.
Maintenance
A BCR-ABL TKI for two years after allogeneic hematopoietic cell transplantation or indefinitely if a transplantation is not performed
Follow-up
Serial bone marrow evaluation and minimal residual disease testing with BCR-ABL transcripts using real time quantitative polymerase chain reaction
Note: The BCR-ABL TKI chosen should be consistent with the BCR-ABL tyrosine kinase used in the specific treatment protocol.
References:
  1. Larson RA, Dodge RK, Burns CP, et al. A five-drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: cancer and leukemia group B study 8811. Blood 1995; 85:2025.
  2. Larson RA, Dodge RK, Linker CA, et al. A randomized controlled trial of filgrastim during remission induction and consolidation chemotherapy for adults with acute lymphoblastic leukemia: CALGB study 9111. Blood 1998; 92:1556.
  3. Ravandi F, O'Brien S, Thomas D, et al. First report of phase 2 study of dasatinib with hyper-CVAD for the frontline treatment of patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia. Blood 2010; 116:2070.
  4. Huguet F, Leguay T, Raffoux E, et al. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol 2009; 27:911.
  5. Wassmann B, Pfeifer H, Goekbuget N, et al. Alternating versus concurrent schedules of imatinib and chemotherapy as front-line therapy for Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL). Blood 2006; 108:1469.
  6. Foà R, Vitale A, Vignetti M, et al. Dasatinib as first-line treatment for adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Blood 2011; 118:6521.
Graphic 63462 Version 1.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟