Kunisada Kodai, Matsuoka Akihito, Yoshida Syunsuke, Taoka Teruhisa
Department of Hematology, Sakaide City Hospital.
Rinsho Ketsueki. 2022;63(12):1621-1625. doi: 10.11406/rinketsu.63.1621.
The optimal regimen for refractory acute myeloid leukemia (AML) in the elderly with good performance status has not been established. A 71-year-old man was admitted to our hospital with pancytopenia and 1.0% blasts in the peripheral blood. The patient was diagnosed with AML with DNMT3A (R882H)- and IDH2 (R172K)-positive myeloblasts. He received a reduced dose of idarubicin and cytarabine therapy. However, induction failure with 20% bone marrow blasts and DNMT3A mutations were observed. A reinduction therapy with venetoclax and azacitidine (VEN+AZA) was administered and led to a sustained complete response with significantly reduced DNMT3A-mutated blasts. Even 9 months after starting VEN+AZA, the patient is still alive and healthy without AML recurrence. Thus, VEN+AZA therapy may be highly effective for treating IDH2- and DNMT3A-mutated AML in elderly patients.
对于身体状况良好的老年难治性急性髓系白血病（AML）患者，尚未确定最佳治疗方案。一名71岁男性因全血细胞减少和外周血原始细胞占1.0%入住我院。该患者被诊断为AML，其原始粒细胞存在DNMT3A（R882H）和IDH2（R172K）阳性突变。他接受了降低剂量的伊达比星和阿糖胞苷治疗。然而，观察到诱导失败，骨髓原始细胞占20%且存在DNMT3A突变。给予维奈托克和阿扎胞苷（VEN+AZA）进行再诱导治疗，结果获得了持续完全缓解，DNMT3A突变的原始细胞显著减少。即使在开始VEN+AZA治疗9个月后，患者仍然存活且健康，无AML复发。因此，VEN+AZA治疗可能对治疗老年IDH2和DNMT3A突变的AML非常有效。
