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急性髓系白血病中不适合强化化疗的患者采用去甲基化药物联合维奈克拉诱导治疗——减少维奈克拉治疗时长的新途径及来自发展中国家有基线感染的患者情况

Hypomethylating agents+venetoclax induction therapy in acute myeloid leukemia unfit for intensive chemotherapy - novel avenues for lesser venetoclax duration and patients with baseline infections from a developing country.

作者信息

Mirgh Sumeet, Sharma Archana, Shaikh Mohammad Rizwan Mohammad Anwar, Kadian Kirti, Agrawal Narendra, Khushoo Vishvdeep, Mehta Pallavi, Ahmed Rayaz, Bhurani Dinesh

机构信息

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.

出版信息

Am J Blood Res. 2021 Jun 15;11(3):290-302. eCollection 2021.

Abstract

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.

摘要

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。

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