Wang Hongxia, Bai Junjun, Pei Zhixin, Zhang Bei, Wang Junjie, Lian Xingli, Song Qinglin
Department of Hematology, Jiaozuo People's Hospital.
Pharmacy Intravennous Admixture Service, Second People's Hospital of Jiaozuo, Jiaozuo, China.
Medicine (Baltimore). 2020 Nov 20;99(47):e23265. doi: 10.1097/MD.0000000000023265.
Some acute myeloid leukemia (AML) patients are unresponsive to treatment or have remission followed by worsening of disease (known as relapsed/refractory AML [R/RAML]) after standardized treatment. The CAG/HAG regimen is not often used clinically because heterogenous patient responses, resistance, and hematopoietic bone marrow dysfunction have been reported with its use. We present 2 cases of R/RAML treated with a new combined therapy (venetoclax+ hypomethylating agents [HMAs]) in which the HAG dose was adjusted and effective in the first course of treatment.
Case 1 involved a 23-year-old man who had suffered from AML for >4 years, and his FLT3 mutation status was positive at the initial diagnosis. After the first course of treatment with the standard-dose "Da" plan, the patient experienced complete remission. During the subsequent courses of treatment, the patient experienced 6 recurrences and was treated with the "ID Ara-C + MIT + sidaaniline" and "CAG + sidaaniline" regimens. However, the disease did not respond. Case 2 involved a 26-year-old man who received chemotherapy with the "Da," "ID Ara-C," "decitabine + half-dose CAG," and "HAE" regimens. In this patients, remission could not be achieved. Reintroduction of the "ia" scheme also failed after treatment in our hospital.
Two patients were diagnosed with R/RAML.
The patient in case 2 received chemotherapy interventions, whereas the patient in case 1 refused to receive medical services at our hospital.
The patient in case 1 was discharged after complete response treatment due to economic reasons and relapsed 2 months later. The patient ultimately died of infection and heart failure. The patient in case 2 is receiving a second cycle of chemotherapy.
We recommend the "venetoclax + HMAs combined with dose-adjusted CAH/HAG" regimen as an effective treatment for adult R/RAML.
一些急性髓系白血病（AML）患者对治疗无反应，或在标准化治疗后缓解但疾病恶化（称为复发/难治性AML [R/RAML]）。CAG/HAG方案在临床上并不常用，因为有报道称其使用存在患者反应异质性、耐药性和造血骨髓功能障碍。我们报告2例R/RAML患者接受一种新的联合疗法（维奈克拉+低甲基化剂[HMAs]）治疗，其中HAG剂量进行了调整且在首个疗程治疗中有效。
病例1为一名23岁男性，患AML超过4年，初诊时FLT3突变状态为阳性。在接受标准剂量“DA”方案的首个疗程治疗后，患者实现完全缓解。在随后的治疗疗程中，患者经历6次复发，并接受了“去甲氧柔红霉素+米托蒽醌+司达安替比林”和“CAG+司达安替比林”方案治疗。然而，疾病无反应。病例2为一名26岁男性，接受了“DA”“去甲氧柔红霉素”“地西他滨+半量CAG”和“HAE”方案化疗。该患者未实现缓解。在我院治疗后重新采用“IA”方案也失败。
两名患者均被诊断为R/RAML。
病例2的患者接受了化疗干预，而病例1的患者因经济原因拒绝在我院接受医疗服务。
病例1的患者在完全缓解治疗后因经济原因出院，2个月后复发。患者最终死于感染和心力衰竭。病例2的患者正在接受第二个化疗周期。
我们推荐“维奈克拉+HMAs联合剂量调整的CAH/HAG”方案作为成人R/RAML的有效治疗方法。
