【摘要】 成人急性淋巴细胞白血病(ALL)是严重危害人类健康的恶性血液病之一，异基因造血干细胞移植(Allo-HSCT)是治愈成人ALL的有效手段。过去10余年中，酪氨酸激酶抑制剂(TKI)、嵌合抗原受体T细胞(CAR-T)、抗CD20或CD22单克隆抗体、贝林妥欧单抗等靶向药物和免疫治疗药物的出现以及儿童方案的应用，不仅提高了对成人ALL的疗效，而且改变了移植适应证。微小残留病(MRD)检测广泛应用于白血病治疗，不仅可用于成人ALL患者的复发预测，而且还可用于治疗方案的选择，促使部分患者应用靶向治疗或免疫治疗就可能获得长期存活。本研究在综述成人ALL患者Allo-HSCT变迁的基础上，探讨我国与欧美国家在移植适应证方面的差别和未来思考与建议：未来的研究应该集中在新生物学标记的鉴定，以便完善成人ALL患者预后分层，进而鉴定出哪些患者需要接受Allo-HSCT以改善预后、达到治愈的目的；哪些患者无需移植就可以获得长期存活，使这些患者免于移植带来的治疗相关死亡和长期并发症等；最终实现生物标记物指导的成人ALL的精准治疗。更多还原

【Abstract】 Adult acute lymphoblastic leukemia(ALL) remains one of the fatal hematologica malignancy. Allogeneic hematopoietic stem cell transplantation(Allo-HSCT) is a curable therapy for adults with ALL. In the past decades, the advent of targeted therapy and immunotherapy, such as tyrosine kinase inhibitor monoclonal antibody against CD20 or CD22, blinatumomab, and chimeric antigen receptor-T cell therapy, not only improved treatment outcomes but also changed transplant indications of adult ALL. Detection of minimal residual disease(MRD) has been routinely applied in clinic for patients with leukemia. MRD determination can be used not only for relapse prediction, but also for treatment selection, making it possible for some patients to achieve long-term survival after targeted therapy or immunotherapy. On the basis of review on the change of transplant indications in adult patients with ALL, this study discussed the differences between China and European and USA in transplantation indications. Future studies should focus on searching for new biomarkers to consummate prognosis stratification of adult patients with ALL and to identify which one could be cured with Allo-HSCT and which one could achieve long-term survival without receiving transplantation in order to avoid transplant-related mortality and long-term complications. The ultimate goal is to realize precision therapy for adult patients with ALL.更多还原