Mirgh Sumeet, Sharma Archana, Shaikh Mohammad Rizwan Mohammad Anwar, Kadian Kirti, Agrawal Narendra, Khushoo Vishvdeep, Mehta Pallavi, Ahmed Rayaz, Bhurani Dinesh
Present address: Department of Medical Oncology, Tata Memorial Centre, ACTREC, Mumbai and Homi Bhabha National Institute Mumbai, India.
Department of Hemato-Oncology and Bone Marrow Transplant, Rajiv Gandhi Cancer Institute and Research Centre Sector 5, Rohini, Delhi 110085, India.
Am J Blood Res. 2021 Jun 15;11(3):290-302. eCollection 2021.
Both elderly acute myeloid leukemia (AML) patients and those with baseline infections, when treated with intensive chemotherapy, are associated with high induction mortality. We report 24 patients (16-newly-diagnosed, 8-relapsed/refractory) with AML deemed unfit for intensive chemotherapy (by virtue of age >60 years, ECOG-PS 3-4, or those with non-resolving infections at baseline), treated with azacytidine-venetoclax combination as induction chemotherapy. Median follow-up of the study group was 8 months. The overall complete remission (CR)+CR with incomplete count recovery (CRi) rate was 58.3%. 1-year progression-free survival and overall survival of the whole cohort was 44.4% and 55.8%, respectively. On subgroup analysis, newly-diagnosed AML (p=0.05), intermediate-risk cytogenetics (p=0.007), and HMA-naïve (p=0.05) patients had a significantly better outcome. AML patients with baseline infections (versus without infections) treated with azacytidine-venetoclax induction, have lesser induction mortality (compared with historic intensive chemotherapy) with equivalent response rates. A detailed analysis amongst cohorts with different venetoclax durations revealed that, shorter duration (<21 days) venetoclax (versus 21-28 days duration) in induction therapy leads to similar response rates and similar severity of myelosuppression, however, with early count recovery and lesser duration of intravenous antibiotics.
老年急性髓系白血病(AML)患者以及那些有基线感染的患者,在接受强化化疗时,诱导死亡率都很高。我们报告了24例被认为不适合强化化疗的AML患者(16例新诊断患者,8例复发/难治性患者,原因是年龄>60岁、东部肿瘤协作组体能状态评分(ECOG-PS)为3 - 4分或基线时有未缓解感染),接受阿扎胞苷-维奈克拉联合方案作为诱导化疗。研究组的中位随访时间为8个月。总体完全缓解(CR)+伴有血细胞计数未完全恢复的CR(CRi)率为58.3%。整个队列的1年无进展生存率和总生存率分别为44.4%和55.8%。亚组分析显示,新诊断的AML患者(p = 0.05)、具有中危细胞遗传学特征的患者(p = 0.007)以及未接受过HMA治疗的患者(p = 0.05)预后明显更好。接受阿扎胞苷-维奈克拉诱导治疗的有基线感染的AML患者(与无感染患者相比),诱导死亡率较低(与既往强化化疗相比),缓解率相当。对不同维奈克拉疗程的队列进行详细分析发现,诱导治疗中维奈克拉疗程较短(<21天)(与21 - 28天疗程相比)导致相似的缓解率和相似的骨髓抑制严重程度,然而,血细胞计数恢复更早,静脉使用抗生素的时间更短。