NEJM:白血病不是“一种病”?
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">作者:解螺旋<span style="color: black;">·叶子</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">如需转载请注明<span style="color: black;">源自</span>:解螺旋·<span style="color: black;">大夫</span><span style="color: black;">研究</span>助手</p><strong style="color: blue;"><span style="color: black;">导语</span></strong><strong style="color: blue;">韩剧有三宝:车祸、失忆、治<span style="color: black;">欠好</span>,白血病<span style="color: black;">始终</span>是“治<span style="color: black;">欠好</span>”中的常客。这病有个特点,易复发,以为治好的时候,<span style="color: black;">忽然</span>就能要了命,全剧终。<span style="color: black;">近期</span>,《NEJM》上的一项<span style="color: black;">科研</span>彻底打破了<span style="color: black;">咱们</span>的常识,<span style="color: black;">发掘</span>白血病中的急性骨髓性白血病(AML),<span style="color: black;">最少</span>是11种不同的<span style="color: black;">疾患</span>。</strong>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这个最耳熟能详的绝症,<span style="color: black;">通常</span>人都<span style="color: black;">晓得</span><span style="color: black;">能够</span>分成急性和慢性两种。急性白血病又分成急性淋巴细胞白血病(ALL)和急性骨髓性白血病(AML)。儿童和青少年<span style="color: black;">病人</span>中,<span style="color: black;">ALL占70%</span>,但其治疗效果这些年来稳步<span style="color: black;">加强</span>,如今<span style="color: black;">5年<span style="color: black;">没</span>事件<span style="color: black;">存活</span>率达到80%</span>。成人初期治疗完全缓解率<span style="color: black;">达到</span>70%以上,约30%<span style="color: black;">上下</span><span style="color: black;">病人</span>有望治愈可能。</p><img src="http://mmbiz.qpic.cn/mmbiz/eycvj9HtnZNjnDysZWPLbkJtn2Rkeaun3lX269GXt3PH39N28RbibzoJK025oOibosPgoroeYpLx7u0bCsHibqWjQ/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"> <strong style="color: blue;">AML竟然多达11种</strong><img src="http://mmbiz.qpic.cn/mmbiz/eycvj9HtnZNjnDysZWPLbkJtn2RkeaunU7oGYFgkjNDUOggVBIXT9GoFz9o8RfpJ5PjXxoVEz9TCorqqoibXRUg/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"> 真正可怕的是AML,<span style="color: black;">本病占小儿白血病的30%</span>,<span style="color: black;">都数</span>病例病情急重,预后凶险,如不<span style="color: black;">即时</span>治疗常可危及生命。<span style="color: black;">况且</span>复发率高,<span style="color: black;">5年内复发率高达70%</span>。韦尔科姆基金会桑格学院<span style="color: black;">科研</span>所的<span style="color: black;">专家</span>们在《NEJM》上<span style="color: black;">发布</span>的一项<span style="color: black;">科研</span><span style="color: black;">发掘</span>,AML<span style="color: black;">最少</span>是11种不同的<span style="color: black;">疾患</span>,<span style="color: black;">况且</span>遗传改变<span style="color: black;">能够</span><span style="color: black;">帮忙</span>解释<span style="color: black;">青年</span>AML<span style="color: black;">病人</span>存活<span style="color: black;">情况</span>的差异,为AML<span style="color: black;">病人</span>的临床<span style="color: black;">实验</span>及<span style="color: black;">病人</span>的诊断和治疗<span style="color: black;">供给</span>策略。<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这是一项大规模<span style="color: black;">科研</span>,招募了1540名AML<span style="color: black;">病人</span>,<span style="color: black;">科研</span>人员们分析了<span style="color: black;">病人</span><span style="color: black;">身体</span><span style="color: black;">诱发</span>白血病的111个基因,其中<span style="color: black;">86%的<span style="color: black;">病人</span>有2个以上驱动基因</span>。<span style="color: black;">这些被<span style="color: black;">科研</span>的<span style="color: black;">病人</span><span style="color: black;">能够</span>被分为<span style="color: black;">最少</span>11个<span style="color: black;">重点</span>的<span style="color: black;">科研</span>组,<span style="color: black;">每一个</span>都有不同的一组遗传改变和独特的临床特征。</span>然而尽管<span style="color: black;">科研</span>者<span style="color: black;">发掘</span>了<span style="color: black;">平常</span>的遗传机制,大部分<span style="color: black;">病人</span>在驱动白血病<span style="color: black;">出现</span>上均<span style="color: black;">拥有</span>特殊的遗传改变组合,这种遗传<span style="color: black;">繁杂</span>性或可<span style="color: black;">帮忙</span>解释<span style="color: black;">为么</span>AML在<span style="color: black;">病人</span>的<span style="color: black;">存活</span>率上表现出了<span style="color: black;">必定</span>的差异性。</p><img src="http://mmbiz.qpic.cn/mmbiz/eycvj9HtnZNjnDysZWPLbkJtn2RkeaunV24TgwMPy5UBL9p1TynCdaGw9oj4NBCjQFZ4icRyQxVeNzCGQZHR4fQ/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">对白血病<span style="color: black;">病人</span>机体的遗传<span style="color: black;">构成</span>进行全面的分析或可从本质上改善<span style="color: black;">科研</span>者预测<span style="color: black;">病人</span><span style="color: black;">是不是</span>会被当前疗法治愈的能力,<span style="color: black;">况且</span><span style="color: black;">关联</span>的<span style="color: black;">科研</span>信息或可被用来设计新型临床<span style="color: black;">实验</span>来<span style="color: black;">研发</span>针对每一种AML亚型的最佳疗法,<span style="color: black;">同期</span>将广泛的遗传测试应用于常规的临床实践中去。<span style="color: black;">例如</span>,对两位<span style="color: black;">病人</span>进行<span style="color: black;">科研</span>,<span style="color: black;">咱们</span>或许<span style="color: black;">能够</span>在显微镜下<span style="color: black;">发掘</span>这两位<span style="color: black;">病人</span>是相同的白血病,但<span style="color: black;">实质</span>上在遗传水平上两位相同的白血病<span style="color: black;">病人</span>之间仍存在多种差异,<span style="color: black;">况且</span>这些遗传差异<span style="color: black;">能够</span><span style="color: black;">帮忙</span>解释<span style="color: black;">为么</span>有些<span style="color: black;">病人</span>能够被治愈,而<span style="color: black;">另一</span>的<span style="color: black;">病人</span>却<span style="color: black;">不可</span>被治愈,尽管<span style="color: black;">她们</span>都接受了相同的疗法进行治疗。利用综合性的分析<span style="color: black;">办法</span>,<span style="color: black;">科研</span>者就<span style="color: black;">能够</span>理解癌症及癌症临床预后<span style="color: black;">病人</span>机体遗传改变之间的<span style="color: black;">繁杂</span>相互<span style="color: black;">功效</span>,这就<span style="color: black;">必须</span>对来自<span style="color: black;">海量</span>病人的样本进行全面的遗传学分析;而深入理解白血病及其它癌症<span style="color: black;">亦</span>将<span style="color: black;">帮忙</span><span style="color: black;">专家</span>们理解<span style="color: black;">疾患</span><span style="color: black;">出现</span>的模式以及<span style="color: black;">病人</span>对疗法的反应<span style="color: black;">状况</span>。<img src="http://mmbiz.qpic.cn/mmbiz/eycvj9HtnZNjnDysZWPLbkJtn2Rkeaun3lX269GXt3PH39N28RbibzoJK025oOibosPgoroeYpLx7u0bCsHibqWjQ/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"> <strong style="color: blue;"><span style="color: black;">为何</span>AML这么容易复发?</strong><img src="http://mmbiz.qpic.cn/mmbiz/eycvj9HtnZNjnDysZWPLbkJtn2RkeaunU7oGYFgkjNDUOggVBIXT9GoFz9o8RfpJ5PjXxoVEz9TCorqqoibXRUg/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"><span style="color: black;">晓得</span>AML<span style="color: black;">实质</span>上是<span style="color: black;">最少</span>11种不同类型白血病的总括后,就<span style="color: black;">能够</span>解析每一种白血病的遗传特性来进行改善临床<span style="color: black;">实验</span>及<span style="color: black;">研发</span>新型的诊断技术了。AML<span style="color: black;">能够</span>影响所有年龄段的个体,<span style="color: black;">病人</span><span style="color: black;">一般</span>在医院<span style="color: black;">必须</span><span style="color: black;">进行数月的集中性化疗<span style="color: black;">办法</span>进行治疗</span>。但仍然有大约三分之二的病人在治疗后<span style="color: black;">显现</span>癌症复发,并<span style="color: black;">最后</span>走向死亡。《Blood》上的一项<span style="color: black;">科研</span>认为,虽然在化疗过程中,几乎所有癌细胞都会<span style="color: black;">出现</span>死亡,<span style="color: black;">然则</span>仍有极少量癌细胞存活下来。这些存活下来的癌细胞会向<span style="color: black;">周边</span>非癌化的细胞发送"求救"信号,<span style="color: black;">从非癌化的基质细胞中"偷取"线粒体,为癌细胞的存活<span style="color: black;">供给</span>了能量</span>,并进一步<span style="color: black;">引起</span>癌症复发。这些存活下来的白血病细胞中,其<span style="color: black;">线粒体含量平均<span style="color: black;">增多</span>了14%,<span style="color: black;">从而</span><span style="color: black;">导致</span>能量合成<span style="color: black;">增多</span>了1.5倍,<span style="color: black;">明显</span><span style="color: black;">加强</span>了癌细胞的<span style="color: black;">存活</span>几率</span>,与此<span style="color: black;">同期</span><span style="color: black;">科研</span>人员还<span style="color: black;">发掘</span>线粒体含量较高的白血病细胞<span style="color: black;">更易</span>对化疗<span style="color: black;">药品</span>产生抵抗。<span style="color: black;">针对</span><span style="color: black;">非常多</span>白血病<span style="color: black;">病人</span>而言,预后<span style="color: black;">状况</span><span style="color: black;">广泛</span>较差,而化疗<span style="color: black;">日前</span>看来<span style="color: black;">亦</span>存在着瓶颈。为此<span style="color: black;">必须</span>对<span style="color: black;">病人</span>进行了<span style="color: black;">仔细</span>的遗传学分析来<span style="color: black;">帮忙</span>更好地理解AML的发病<span style="color: black;">原由</span>,<span style="color: black;">同期</span><span style="color: black;">亦</span>要理解<span style="color: black;">诱发</span>AML的不同进化路径,<span style="color: black;">研发</span>出针对不同AML<span style="color: black;">病人</span>的信息港个体化疗法。<img src="http://mmbiz.qpic.cn/mmbiz/eycvj9HtnZNmwQD9ia8hW7AuqrX0sr2k5yM2vYppuRPfBYPxXKk0cnqWA868nmsD18yYtYfxKWrQ37y3B41Xofw/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; 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