Zaytsev Daniil, Girshova Larisa, Ivanov Vladimir, Budaeva Irina, Motorin Dmitri, Badaev Renat, Mirolubova Julia, Grobovenko Evgeni, Chitanava Tamara, Zaykova Ekaterina, Alexeeva Julia, Zaritskey Andrey
Almazov National Medical Research Centre, 2 Akkuratova street, 197341 St. Petersburg, Russia.
Biology (Basel). 2020 Feb 10;9(2):28. doi: 10.3390/biology9020028.
To the best of our knowledge, data from Gemtuzumab ozogamicin in Acute Myeloid Leukemia (AML) patients with failure of organ functions and poor performance status are extremely lacking. Moreover, the fast recovery from organ failure, after Gemtuzumab ozogamicin administration, has never been reported. This study aimed to demonstrate the efficacy and rapid response of Gemtuzumab ozogamicin in refractory acute myeloid leukemia (AML) patients with pulmonary and kidney failure and poor performance status. Three refractory AML patients, with organ dysfunction, are described. One patient was pre-treated with intensive chemotherapy, and two other patients progressed during Azacitidine treatment. Two patients had respiratory failure grade 2 and one patient suffered from acute kidney insufficiency. Two patients were highly febrile with an elevated С-Reactive Protein (CRP) level. The WHO performance status of three was measured in all patients. Gemtuzumab ozogamicin administration was performed in three patients, followed by a further switch to Gemtuzumab ozogamicin + Azacitidine or "7+3" treatment.
Gemtuzumab ozogamicin administration resulted in abrupt fever cessation in two febrile patients simultaneously with a rapid decrease in CRP level and fast resolution of respiratory failure. Recovery of kidney function was noticed rapidly in patients with renal insufficiency. The WHO performance status was elevated in all three patients. No adverse grade II-III effects were noticed. Further treatment made two patients eligible for intensive chemotherapy, one patient underwent allogeneic stem cell transplantation, and the patient with kidney failure obtained complete remission.
Gemtuzumab ozogamicin therapy appeared to be safe and highly efficacious in relapsed/refractory AML patients with organ dysfunction, like pulmonary or renal failure and poor performance status, and may contribute to rapid recovery from organ failures.
据我们所知，关于吉妥单抗奥唑米星用于器官功能衰竭且体能状态较差的急性髓系白血病（AML）患者的数据极其匮乏。此外，从未有过关于吉妥单抗奥唑米星给药后器官功能快速恢复的报道。本研究旨在证明吉妥单抗奥唑米星在伴有肺和肾功能衰竭且体能状态较差的难治性急性髓系白血病（AML）患者中的疗效和快速反应。描述了3例伴有器官功能障碍的难治性AML患者。1例患者接受过强化化疗预处理，另外2例患者在阿扎胞苷治疗期间病情进展。2例患者有2级呼吸衰竭，1例患者患有急性肾功能不全。2例患者高热，C反应蛋白（CRP）水平升高。所有患者均评估了世界卫生组织体能状态。对3例患者给予吉妥单抗奥唑米星治疗，随后进一步换用吉妥单抗奥唑米星+阿扎胞苷或“7+3”方案治疗。
给予吉妥单抗奥唑米星后，2例发热患者的发热症状突然停止，同时CRP水平迅速下降，呼吸衰竭快速缓解。肾功能不全患者的肾功能迅速恢复。所有3例患者的世界卫生组织体能状态均有所改善。未观察到II - III级不良反应。进一步治疗使2例患者符合强化化疗条件，1例患者接受了异基因干细胞移植，肾功能衰竭患者获得完全缓解。
吉妥单抗奥唑米星治疗对于伴有器官功能障碍（如肺或肾衰竭）且体能状态较差的复发/难治性AML患者似乎安全且高效，可能有助于器官功能的快速恢复。
