文章：

成人急性淋巴细胞白血病治疗中的前期免疫疗法策略

Upfront Immunotherapy Approaches in the Management of Adults with Acute Lymphoblastic Leukemia

原文发布日期：23 August 2025

DOI: 10.3390/cancers17172746

类型: Article

开放获取: 是

英文摘要：

The therapeutic landscape of adults with B-cell precursor acute lymphoblastic leukemia (BCP-ALL) is undergoing a paradigm shift, driven by the development of immunotherapy-based “chemo-free” and “chemo-light’ regimens. These strategies aim to achieve high efficacy with reduced toxicity, particularly in older adults who may not tolerate intensive chemotherapy. In Philadelphia chromosome-positive (Ph+) BCP-ALL, the incorporation of ABL tyrosine kinase inhibitors (TKIs) with blinatumomab (CD3/CD19 bispecific T-cell engager) has shown remarkable efficacy, with some studies reporting molecular response rates in the range of 90–100% and long-term survival exceeding 80% without the need for intensive chemotherapy or allogeneic hematopoietic cell transplantation (allo-HCT). In Philadelphia-negative (Ph−) BCP- ALL, an immunotherapy-based combination of blinatumomab and inotuzumab ozogamicin (anti-CD22 antibody-drug conjugate) has demonstrated high rates of complete remission and measurable residual disease (MRD) negativity, with manageable toxicity. While chimeric antigen receptor (CAR) T-cell therapy remains a transformative option for relapsed/refractory B-ALL, its integration into frontline treatment is still under investigation. Ongoing trials are evaluating the optimal sequencing and combinations of these agents and their potential to obviate the need for chemotherapy and/or allo-HCT in selected patients. As evidence continues to accumulate, chemo-free and chemo-light regimens, incorporating minimal chemotherapy with targeted agents to balance efficacy and reduced toxicity, are poised to redefine the standard of care for adults BCP-ALL, offering the possibility of durable remissions with reduced treatment-related morbidity.

摘要翻译： 

成人B细胞前体急性淋巴细胞白血病（BCP-ALL）的治疗格局正在经历范式转变，这一转变由基于免疫治疗的“无化疗”和“轻化疗”方案的发展所驱动。这些策略旨在实现高效低毒的治疗效果，尤其适用于无法耐受强化化疗的老年患者。在费城染色体阳性（Ph+）BCP-ALL中，ABL酪氨酸激酶抑制剂（TKIs）与贝林妥欧单抗（CD3/CD19双特异性T细胞衔接器）的联合应用显示出显著疗效，部分研究报道其分子学缓解率达90%-100%，且无需强化化疗或异基因造血细胞移植（allo-HCT）即可实现超过80%的长期生存率。在费城染色体阴性（Ph−）BCP-ALL中，基于免疫治疗的贝林妥欧单抗与奥加伊妥珠单抗（抗CD22抗体-药物偶联物）联合方案已展现出较高的完全缓解率和可测量残留病（MRD）阴性率，且毒性可控。尽管嵌合抗原受体（CAR）T细胞疗法仍是复发/难治性B-ALL的革命性选择，但其在一线治疗中的应用仍在探索中。当前多项试验正在评估这些药物的最佳序贯与组合方案，及其在特定患者中替代化疗和/或allo-HCT的潜力。随着证据不断积累，结合最低强度化疗与靶向药物以平衡疗效与毒性的“无化疗”和“轻化疗”方案，有望重新定义成人BCP-ALL的标准治疗方案，为实现持久缓解并降低治疗相关并发症提供可能。

原文链接：

Upfront Immunotherapy Approaches in the Management of Adults with Acute Lymphoblastic Leukemia