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急性髓系白血病发病机制研究进展及治疗开发挑战

英文原题:Advances in pathogenesis research and challenges in treatment development for acute myeloid leukemia.

查看英文原题

Advances in pathogenesis research and challenges in treatment development for acute myeloid leukemia.

PubMed 2024/09/03(内容时间) Int J Hematol Q3 · IF 1.9(JCR 2025)

研究概要

急性髓系白血病(AML)发生于造血干细胞获得染色体和基因异常,转化为白血病干细胞(LSCs),并进一步获得驱动突变时。

中文摘要

急性髓系白血病(AML)发生于造血干细胞获得染色体和基因异常后,转化为白血病干细胞(LSCs)并进一步获得驱动突变。基因组分析的进展已鉴定出众多参与AML发生的新基因突变。近期研究表明,携带DDX41和CEBPA等基因胚系突变的个体在获得额外体细胞突变后发生AML,最新的WHO分类将伴有此类突变的AML划分为独立的疾病组。LSCs受不同于正常干细胞的代谢过程调控,导致耐药和复发。LSCs依赖氧化磷酸化(OXPHOS)代谢产生能量,venetoclax抑制该过程,从而影响LSCs。耐药的LSCs表现出增强的糖酵解,这提示同时靶向OXPHOS和糖酵解至关重要。尽管FLT3、BCL-2和IDH抑制剂等靶向治疗已显示出疗效,但耐药仍是问题,凸显了开发新治疗策略的必要性。CAR-T细胞治疗是一种新兴的免疫疗法,在靶向CD123和CLL-1方面显示出特别的前景,且毒性可接受。未来CAR-T细胞治疗和其他免疫疗法的发展有望改善AML的治疗结局。

展开英文摘要原文

Acute myeloid leukemia (AML) develops when hematopoietic stem cells acquire chromosomal and genetic abnormalities, transforming into leukemia stem cells (LSCs) and further gaining driver mutations. Advances in genomic analysis have identified numerous new gene mutations involved in AML development. Recent research has shown that individuals with germline mutations in genes like DDX41 and CEBPA develop AML upon acquiring additional somatic mutations, and the latest WHO classification separates AML with such mutations into distinct disease groups. LSCs are regulated by different metabolic processes than normal stem cells, contributing to drug resistance and relapse. LSCs rely on oxidative phosphorylation (OXPHOS) metabolism for energy production, and venetoclax inhibits this process, affecting LSCs. Resistant LSCs show enhanced glycolysis, which suggests that targeting both OXPHOS and glycolysis is crucial. While targeted therapies like FLT3, BCL-2, and IDH inhibitors have shown efficacy, resistance remains an issue, highlighting the need for new treatment strategies. CAR-T cell therapy is an emerging immunotherapy that shows particular promise for targeting CD123 and CLL-1, with acceptable toxicity. Future developments in CAR-T cell therapy and other immunotherapies are anticipated to improve AML treatment outcomes.

论文信息

作者
Yamaguchi H
单位
Department of Hematology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan. y-hiroki@fd6.so-net.ne.jp.Japan
文献类型
综述
期刊
International journal of hematology2024 Oct
原文标识
PubMed 39225969 · DOI 10.1007/s12185-024-03837-6