Iqbal Asif, Dubey Manas, Randhawa Amritjot Singh, Khanikar Duncan, Hazarika Munlima, Roy Partha S, Dutta Chayanika, Barbhuiyan Suhani, Deka Roopam
Adult Hematology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, IND.
Medical Oncology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, IND.
Cureus. 2024 Jan 31;16(1):e53303. doi: 10.7759/cureus.53303. eCollection 2024 Jan.
The aggressive, genetically diverse group of malignant illnesses known as acute myeloid leukemia (AML) is characterized by clonally related myeloblast invasion of the bone marrow, blood, and other organs. The treatment regimen plays a crucial role in the management of AML, and it is associated with poor overall survival and enhanced risk of relapse. Induction therapy with a 7+3 DA regimen (daunorubicin + ara-C) has been the treatment of choice for young and fit patients.
To evaluate the effect of dose modification in young and fit patients for a modified treatment regimen.
This was a retrospective, observational study of AML patients to analyze the outcomes of modified induction therapy in AML patients enrolled at Dr. B. Borooah Cancer Institute, Guwahati, Assam, India, from October 2021 to March 2022. The outcomes of modified induction therapy with intensive chemotherapy (modified 7+3 DA) and low-intensity chemotherapy decitabine (10 days) and venetoclax + azacytidine (seven days) were considered after the first two cycles or 60 days, whichever was earlier.
Data from 31 patients with de-novo AML was analyzed; the median age of the patients was 41 years (range: 2-71 years), and the male-to-female ratio was 1.8. There were seven patients in the pediatric age group (2-13 years), and 19%, 65%, and 13% of patients belonged to favorable, intermediate, and high-risk groups, respectively. With regards to modified induction therapy (n=31), 20 (65%) patients received modified "7+3 DA", nine (29%) received hypomethylating agents (HMA, decitabine only), and two patients received HMA (azacitidnie) + venetoclax. Additionally, 23/31 patients completed at least two cycles of induction therapy. Overall, 60 day-induction mortality was 13%, and the complete remission (CR) and partial remission (PR) rates were 48% and 26%, respectively. In patients who received modified "7+3 DA", the CR rate was 55%.
The notable reduction in deaths due to infections observed in our study suggests that centers with limited resources for preventing neutropenic complications during induction therapies in AML patients could consider adopting this modified regimen.
急性髓系白血病（AML）是一组侵袭性强、基因多样的恶性疾病，其特征是骨髓、血液和其他器官中出现克隆相关的成髓细胞浸润。治疗方案在AML的管理中起着关键作用，且与总体生存率低和复发风险增加相关。采用7+3 DA方案（柔红霉素+阿糖胞苷）进行诱导治疗一直是年轻且身体状况良好患者的首选治疗方法。
评估在年轻且身体状况良好的患者中调整剂量对改良治疗方案的效果。
这是一项对AML患者的回顾性观察研究，旨在分析2021年10月至2022年3月在印度阿萨姆邦古瓦哈蒂的B. Borooah癌症研究所登记的AML患者改良诱导治疗的结果。在前两个周期或60天（以较早者为准）后，考虑强化化疗（改良7+3 DA）、低强度化疗地西他滨（10天）以及维奈克拉+阿扎胞苷（7天）的改良诱导治疗结果。
分析了31例初发AML患者的数据；患者的中位年龄为41岁（范围：2 - 71岁），男女比例为1.8。儿科年龄组（2 - 13岁）有7例患者，分别有19%、65%和13%的患者属于低危、中危和高危组。关于改良诱导治疗（n = 31），20例（65%）患者接受改良的“7+3 DA”，9例（29%）接受去甲基化药物（HMA，仅地西他滨），2例患者接受HMA（阿扎胞苷）+维奈克拉。此外，23/31例患者完成了至少两个周期的诱导治疗。总体而言，60天诱导死亡率为13%，完全缓解（CR）率和部分缓解（PR）率分别为48%和26%。接受改良“7+3 DA”的患者中，CR率为55%。
我们的研究中观察到因感染导致的死亡显著减少，这表明在AML患者诱导治疗期间预防中性粒细胞减少并发症资源有限的中心可以考虑采用这种改良方案。
