AYA世代の急性骨髄性白血病 —内科の立場から—  [in Japanese] Acute myeloid leukemia in adolescents and young adults: from the viewpoint of physicians  [in Japanese]

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Author(s)

    • 鍬塚 八千代 KUWATSUKA Yachiyo
    • 名古屋大学医学部附属病院 先端医療・臨床研究支援センター Center for Advanced Medicine and Clinical Research, Nagoya University Hospital

Abstract

<p>思春期・若年成人(AYA)世代の急性骨髄性白血病(AML)の生存率は,小児と比較して同等あるいは不良と報告されている。急性リンパ性白血病とは異なり,AYA世代のAMLに対して治療強度が高い小児レジメンの成績が勝るとのエビデンスは示されていない。近年AMLに関与する遺伝子異常と予後との関連が明らかになってきており,遺伝子変異を加味した予後層別化システムが提唱されている。小児と成人における遺伝子変異の頻度は異なるがAYA世代での検討は今後の課題である。AYA世代のがんではがんの生物学的特性以外にも治療コンプライアンスの低下などが治療成績に影響を与えるとされる。心理社会的ケア,小児診療施設からの移行,サバイバーシップにおける妊孕性に関わる対応などにおいてもAYA世代特有の配慮が望まれるが,AYA世代の特殊性を十分配慮したサポートの提供は成人診療施設における今後の課題である。</p>

<p>Based on various studies, the survival of adolescent and young adults (AYAs) with acute myeloid leukemia (AML) was reportedly similar to or worse than younger children. AYAs with AML treated in adult institutions are usually offered the same treatment as that of the older adults. Although pediatric protocols generally include intensified regimens compared with adult protocols, it is still controversial whether an intensified pediatric AML regimen results in an improved survival for the AYA population. Somatic mutations have proven to be significantly prognostic in AML. Although such molecular markers are becoming increasingly important as a means of risk stratification for both children and adults with AML, the prevalence and significance of somatic mutations remain largely unknown in AYAs with AML. In addition to the biological characteristics of cancer, non-biological factors, such as compliance with treatment, may influence the treatment outcomes of AYAs. AYAs have specific and unique needs that are different from children and older adults such as psychosocial care, transition from the pediatric to adult care environment, and fertility considerations among long-term survivors. A further multidisciplinary approach for AYAs with AML is still an issue among adult institutes.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 58(8), 1047-1052, 2017

    The Japanese Society of Hematology

Codes

  • NII Article ID (NAID)
    130006067959
  • NII NACSIS-CAT ID (NCID)
    AN00252940
  • Text Lang
    JPN
  • ISSN
    0485-1439
  • NDL Article ID
    028516071
  • NDL Call No.
    Z19-295
  • Data Source
    NDL  J-STAGE 
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