Scheckel Caleb J, Meyer Megan, Betcher Jeffrey Alan, Al-Kali Aref, Foran James, Palmer Jeanne
Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic Minnesota, Rochester, MN, United States.
Department of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, United States.
Leuk Res. 2020 Mar;90:106300. doi: 10.1016/j.leukres.2020.106300. Epub 2020 Jan 28.
Salvage therapy regimens for refractory and relapsed AML include mitoxantrone, etoposide, and cytarabine (MEC) and cladribine, cytarabine, filgrastim, and mitoxantrone (CLAG-M). We analyzed patients receiving either CLAG-M or MEC as salvage therapy for RR-AML between 09/01/2009-12/31/2017. Of 150 patients with RR-AML, 34 patients received CLAG-M and 116 MEC. CR/CRi rates for CLAG-M and MEC were 61.3 % (19/31) and 55.6 % (60/108). Median OS was 9.5 months for CLAG-M and 10.0 months for MEC (HR = 0.88,95 %CI = 0.54-1.41,p = 0.59). 76 patients proceeded to ASCT following salvage therapy. Median OS after ASCT was 13.0 months for CLAG-M and 31.0 months for MEC (HR = 1.76,95 %CI = 0.87-3.56,p = 0.12). Among those with late relapse and ASCT, median OS was 9.0 and 48.0 months for CLAG-M and MEC, respectively (HR = 17.6,95 %CI = 1.57-198,p < 0.001). There were no significant differences in outcome between CLAG-M vs. MEC regardless of transplant status. There was a significant improvement in survival in patients with late relapse treated with MEC who proceeded to ASCT.
难治性和复发性急性髓系白血病（AML）的挽救治疗方案包括米托蒽醌、依托泊苷和阿糖胞苷（MEC）以及克拉屈滨、阿糖胞苷、非格司亭和米托蒽醌（CLAG-M）。我们分析了在2009年9月1日至2017年12月31日期间接受CLAG-M或MEC作为挽救治疗RR-AML的患者。在150例RR-AML患者中，34例接受CLAG-M治疗，116例接受MEC治疗。CLAG-M和MEC的完全缓解/血液学不完全缓解（CR/CRi）率分别为61.3%（19/31）和55.6%（60/108）。CLAG-M组的中位总生存期（OS）为9.5个月，MEC组为10.0个月（风险比[HR]=0.88，95%置信区间[CI]=0.54-1.41，p=0.59）。76例患者在挽救治疗后进行了异基因造血干细胞移植（ASCT）。CLAG-M组ASCT后的中位OS为13.0个月，MEC组为31.0个月（HR=1.76，95%CI=0.87-3.56，p=0.12）。在晚期复发且接受ASCT的患者中，CLAG-M组和MEC组的中位OS分别为9.0个月和48.0个月（HR=17.6，95%CI=1.57-198，p<0.001）。无论移植状态如何，CLAG-M与MEC之间的结局无显著差异。接受MEC治疗并进行ASCT的晚期复发患者的生存率有显著改善。
