作者
马燕芳,赵 敏,陈虹冰,黄 艳
文章摘要
急性髓系白血病是一类起源于造血干细胞或祖细胞的侵袭性血液系统恶性肿瘤,药物治疗是核心手段。随着分子生物学与精准医学的发展,AML治疗领域取得诸多突破性进展。本文系统梳理急性髓系白血病药物治疗的最新研究成果,重点阐述FLT3、IDH1/2、Menin等关键靶点的分子机制、靶向治疗策略突破、免疫治疗创新方向的进展,分析耐药机制及应对策略,为临床实践与后续研究提供参考。
文章关键词
急性髓系白血病;靶向治疗;免疫治疗;Menin抑制剂;BCL-2抑制剂;CAR-NK细胞疗法
参考文献
[1] CAO L,WANG Z,CUI Y,et al.Emerging strategies and novel therapeutic targets in acute myeloid leukemia:current advances and future directions[J].Biomarker research,2025,13(1):127.
[2] ZHOU Y,HUANG G,CAI X,et al.Global,regional,and national burden of acute myeloid leukemia,1990-2021:a systematic analysis for the global burden of disease study 2021[J].Biomarker research,2024,12(1):101.
[3] 中华医学会血液学分会白血病淋巴瘤学组.中国复发难治性急性髓系白血病诊疗指南(2023年版)[J].中华血液学杂志,2023, 44(09):713-716.
[4] ALMATANI M F,ALI A,ONYEMAECHI S,et al.Strategies targeting FLT3 beyond the kinase inhibitors[J].Pharmacology&therapeutics, 2021,225:107844.
[5] YU Z,DU J,HUI H,et al.LT-171-861,a novel FLT3 inhibitor,shows excellent preclinical efficacy for the treatment of FLT3 mutant acute myeloid leukemia[J].Theranostics,2021,11(1):93-106.
[6] DAVER N,VENUGOPAL S,RAVANDI F.FLT3 mutated acute myeloid leukemia:2021 treatment algorithm[J].Blood cancer journal, 2021,11(5):104.
[7] FRUCHTMAN H,AVIGAN Z M,WAKSAL J A,et al.Management of isocitrate dehydrogenase 1/2 mutated acute myeloid leukemia[J]. Leukemia,2024,38(5):927-935.
[8] SASAKI K,RAVANDI F,KADIA T M,et al.Prediction of survival with lower intensity therapy among older patients with acute myeloid leukemia[J].Cancer,2023,129(7):1017-1029.
[9] YANG W,XU J,CAO S,et al.Differential impact of IDH1/2 mutations on outcome in adult acute myeloid leukemia patients[J].Cancer genetics,2025,298-299:133-140.
[10] NADIMINTI K V G,SAHASRABUDHE K D,LIU H.Menin inhibitors for the treatment of acute myeloid leukemia:challenges and opportunities ahead[J].Journal of hematology&oncology,2024,17(1):113.
[11] THOMAS X.Small Molecule Menin Inhibitors:Novel Therapeutic Agents Targeting Acute Myeloid Leukemia with KMT2A Rearrangement or NPM1 Mutation[J].Oncology and therapy,2024,12(1):57-72.
[12] AN Z,ZHANG X.Menin inhibitors for acute myeloid leukemia:latest updates from the 2023 ASH Annual Meeting[J].Journal of hematology&oncology,2024,17(1):52.
[13] D HNER H,WEI A H,L WENBERG B.Towards precision medicine for AML[J].Nature reviews.Clinical oncology,2021,18(9):577-590.
[14] SALMON J M,TODOROVSKI I,STANLEY K L,et al.Epigenetic Activation of Plasmacytoid DCs Drives IFNAR-Dependent Therapeutic Differentiation of AML[J].Cancer discovery,2022,12(6):1560-1579.
[15] MORAN B,DAVERN M,REYNOLDS J V,et al.The impact of histone deacetylase inhibitors on immune cells and implications for cancer therapy[J].Cancer letters,2023,559:216121.
[16] BAI J,WANG T,LI J,et al.Efficacy and safety of venetoclax and azacitidine for acute myeloid leukemia in China:a real-world single- center study[J].BMC cancer,2025,25(1):990.
[17] KAPOOR I,BODO J,HILL B T,et al.Targeting BCL-2 in B-cell malignancies and overcoming therapeutic resistance[J].Cell death& disease,2020,11(11):941.
[18] VALENTIN R,GRABOW S,DAVIDS M S.The rise of apoptosis:targeting apoptosis in hematologic malignancies[J].Blood,2018, 132(12):1248-1264.
[19] ZHU R,LI L,NGUYEN B,et al.FLT3 tyrosine kinase inhibitors synergize with BCL-2 inhibition to eliminate FLT3/ITD acute leukemia cells through BIM activation[J].Signal transduction and targeted therapy,2021,6(1):186.
[20] DESAI S R,CHAKRABORTY S,SHASTRI A.Mechanisms of resistance to hypomethylating agents and BCL-2 inhibitors[J].Best practice&research.Clinical haematology,2023,36(4):101521.
[21] KANTARJIAN H,BORTHAKUR G,DAVER N,et al.Current status and research directions in acute myeloid leukemia[J].Blood cancer journal,2024,14(1):163.
[22] ALEXANDER E.PERL M Q L M.Clinical Outcomes Following Treatment with Gilteritinib or Quizartinib in Patients with Relapsed/ Refractory FLT3-ITD+Acute Myeloid Leukemia[J].Blood,2020(136(Supplement 1)):42-43.
[23] KOSCHADE S E,KLANN K,SHAID S,et al.Translatome proteomics identifies autophagy as a resistance mechanism to on-target FLT3 inhibitors in acute myeloid leukemia[J].Leukemia,2022,36(10):2396-2407.
[24] LI Y,SHARMA A,SCHMIDT-WOLF I G H.Evolving insights into the improvement of adoptive T-cell immunotherapy through PD-1/PD-L1 blockade in the clinical spectrum of lung cancer[J].Molecular cancer,2024,23(1):80.
[25] ALVARADO-VALERO Y,COOK R J,DINNER S N,et al.The oral CDK9 inhibitor voruciclib combined with venetoclax for patients with relapsed/refractory acute myeloid leukemia[J].Blood neoplasia,2025,2(3):100108.
[26] LOGES S,HEUSER M,CHROMIK J R,et al.Bemcentinib as monotherapy and in combination with low-dose cytarabine in acute myeloid leukemia patients unfit for intensive chemotherapy:a phase 1b/2a trial[J].Nature communications,2025,16(1):2846.
[27] YAO M,YAN W,WANG Y,et al.IHCH9033,a novel class I HDAC inhibitor,synergizes with FLT3 inhibitor and rescues quizartinib resistance in FLT3-ITD AML via enhancing DNA damage response[J].Experimental hematology&oncology,2025,14(1):15.
[28] BOULIGNY I M,MONTALBAN-BRAVO G,SASAKI K,et al.A phase II trial of azacitidine with ipilimumab,nivolumab,or ipilimumab and nivolumab in previously untreated myelodysplastic syndrome[J].Haematologica,2025,110(7):1628-1633.
[29] ZHAO J,WU S,WANG D,et al.Panobinostat sensitizes AraC-resistant AML cells to the combination of azacitidine and venetoclax[J]. Biochemical pharmacology,2024,228:116065.
[30] ANDERSON N R,SHETH V,LI H,et al.Microenvironmental CXCL12 deletion enhances Flt3-ITD acute myeloid leukemia stem cell response to therapy by reducing p38 MAPK signaling[J].Leukemia,2023,37(3):560-570.
[31] QIU S,KUMAR H,YAN C,et al.Autophagy inhibition impairs leukemia stem cell function in FLT3-ITD AML but has antagonistic interactions with tyrosine kinase inhibition[J].Leukemia,2022,36(11):2621-2633.
[32] KELLY L M,RUTTER J C,LIN K H,et al.Targeting a lineage-specific PI3K?-Akt signaling module in acute myeloid leukemia using a heterobifunctional degrader molecule[J].Nature cancer,2024,5(7):1082-1101.
[33] JEN E Y,KO C,LEE J E,et al.FDA Approval:Gemtuzumab Ozogamicin for the Treatment of Adults with Newly Diagnosed CD33-Positive Acute Myeloid Leukemia[J].Clinical cancer research:an official journal of the American Association for Cancer Research, 2018,24(14):3242-3246.
[34] COLLADOS-ROS A,MURO M,LEGAZ I.Gemtuzumab Ozogamicin in Acute Myeloid Leukemia:Efficacy,Toxicity,and Resistance Mechanisms-A Systematic Review[J].Biomedicines,2024,12(1):208.
[35] MAI S,HODGES A,CHEN H,et al.LILRB3 Modulates Acute Myeloid Leukemia Progression and Acts as an Effective Target for CAR T-cell Therapy[J].Cancer research,2023,83(24):4047-4062.
[36] DAVER N,ALOTAIBI A S,BÜCKLEIN V,et al.T-cell-based immunotherapy of acute myeloid leukemia:current concepts and future developments[J].Leukemia,2021,35(7):1843-1863.
[37] BHAGWAT A S,TORRES L,SHESTOVA O,et al.Cytokine-mediated CAR T therapy resistance in AML[J].Nature medicine,2024, 30(12):3697-3708.
[38] HUANG R,WANG X,YAN H,et al.Safety and efficacy of CD33-targeted CAR-NK cell therapy for relapsed/refractory AML: preclinical evaluation and phase I trial[J].Experimental hematology&oncology,2025,14(1):1.
[39] MARIN D,LI Y,BASAR R,et al.Safety,efficacy and determinants of response of allogeneic CD19-specific CAR-NK cells in CD19(+)B cell tumors:a phase 1/2 trial[J].Nature medicine,2024,30(3):772-784.
Full Text:
DOI