Department of Hematology, Zhujiang Hospital of Southern Medical University, Guangzhou, China.
Department of Hematology, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
Cancer. 2024 Jul 15;130(14):2472-2481. doi: 10.1002/cncr.35278. Epub 2024 Mar 12.
Both venetoclax plus a hypomethylating agent (VEN/HMA) and cytarabine, aclarubicin, and granulocyte colony-stimulating factor (CAG) are low-intensity regimens for older patients with acute myeloid leukemia (AML) that show good efficacy and safety. It is unknown how VEN/HMA compares with the CAG regimen for the treatment of newly diagnosed AML.
The outcomes of patients with newly diagnosed AML treated with VEN/HMA were compared with those of patients treated with a CAG-based regimen. Propensity score matching between these two cohorts at a 1:1 ratio was performed according to age at diagnosis, sex, Eastern Cooperative Oncology Group performance status, state of fitness, and European LeukemiaNet (ELN) 2022 risk stratification to minimize bias.
A total of 84 of 96 patients in the VEN/HMA cohort were matched with 84 of 147 patients in the CAG cohort. VEN/HMA resulted in a better response than the CAG-based regimens, as indicated by a higher composite complete remission (CRc) rate (82.1% vs. 60.7%; p = .002) and minimal residual disease negativity rate (88.2% vs. 68.2%; p = .009). In patients with an ELN adverse risk, VEN/HMA was associated with a higher CRc rate compared to CAG (80.5% vs. 58.3%; p = .006). VEN/HMA was associated with longer event-free survival (EFS) (median EFS, not reached vs. 4.5 months; p = .0004), whereas overall survival (OS) was comparable between the two cohorts (median OS, not reached vs. 18 months; p = .078).
The VEN/HMA regimen may result in a better response than CAG-based treatment in older patients with newly diagnosed AML.
维奈克拉联合低甲基化剂（VEN/HMA）和阿糖胞苷、阿克拉霉素和粒细胞集落刺激因子（CAG）均为低强度方案，适用于老年急性髓系白血病（AML）患者，疗效和安全性良好。尚不清楚 VEN/HMA 方案与 CAG 方案治疗新诊断 AML 的疗效相比如何。
比较新诊断 AML 患者接受 VEN/HMA 治疗的结果与接受 CAG 为基础方案治疗的结果。采用倾向评分匹配法，以诊断时的年龄、性别、东部肿瘤协作组体能状态、身体状况和欧洲白血病网（ELN）2022 风险分层为 1:1 进行匹配，以尽量减少偏倚。
VEN/HMA 组的 96 例患者中共有 84 例与 CAG 组的 147 例患者相匹配。与 CAG 为基础的方案相比，VEN/HMA 方案产生了更好的反应，表现为更高的复合完全缓解率（CRc）（82.1% vs. 60.7%；p=0.002）和更低的微小残留病阴性率（88.2% vs. 68.2%；p=0.009）。在具有 ELN 不良风险的患者中，与 CAG 相比，VEN/HMA 与更高的 CRc 率相关（80.5% vs. 58.3%；p=0.006）。VEN/HMA 与更长的无事件生存（EFS）相关（中位 EFS，未达到 vs. 4.5 个月；p=0.0004），而两组的总生存（OS）无差异（中位 OS，未达到 vs. 18 个月；p=0.078）。
在新诊断的 AML 老年患者中，VEN/HMA 方案可能比 CAG 为基础的治疗方案产生更好的反应。
