Xu Fangfei, Zhou Kuangguo, Gong Duanhao, Huang Wei
Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei 430030, China.
Ther Adv Hematol. 2024 Sep 18;15:20406207241275850. doi: 10.1177/20406207241275850. eCollection 2024.
The response rate of traditional first-line induction chemotherapy (IC) for newly diagnosed acute myeloid leukemia needs to be improved, but it is not clear whether adding venetoclax or hypomethylating agents (HMAs) to IC will improve the response rate.
To determine whether venetoclax or HMAs could increase the response rate of IC in patients with newly diagnosed acute myeloid leukemia (AML).
A retrospective, propensity score matching analysis.
Newly diagnosed AML patients at Tongji Hospital between 2021 and 2023 were included in this study. By matching cases and controls based on age, gender, baseline bone marrow blast cell proportion, type of AML, and the National Comprehensive Cancer Network (NCCN) risk stratification group, we compared the response rate (CR, CR/CRi, ORR, and MRD negative) and hematological adverse events in newly diagnosed AML treated with IC plus venetoclax or HMAs versus IC alone after one cycle of IC.
The addition of venetoclax could improve CR/CRi of IC (83.8% for IC plus venetoclax vs 66.1% for IC alone, = 0.029). The addition of venetoclax to IA regimen did not improve CR/CRi of IA regimen (76.9% for IA plus venetoclax vs 76.2% for IA alone, = 0.986). The addition of HMAs could not only improves CR/CRi of IC (85.3%% for IC plus HMAs vs 65.4% for IC alone, = 0.002) but also improves CR/CRi of IA regimen (91.3% for IA plus HMAs vs 70.0% for IA alone, = 0.034). The addition of HMAs could improve CR/CRi of patients with adverse mutations (FLT3, IDH1/2, K/NRAS) after IC. The addition of venetoclax and HMAs both extended the duration of agranulocytosis and thrombocytopenia.
Adding HMAs might improve CR/CRi of IC including IA. Adding venetoclax might not improve CR/CRi of IA. A well-designed prospective randomized controlled study is now warranted.
新诊断急性髓系白血病的传统一线诱导化疗（IC）缓解率有待提高，但IC联合维奈克拉或去甲基化药物（HMAs）是否能提高缓解率尚不清楚。
确定维奈克拉或HMAs能否提高新诊断急性髓系白血病（AML）患者IC的缓解率。
一项回顾性倾向评分匹配分析。
纳入2021年至2023年在同济医院新诊断的AML患者。通过根据年龄、性别、基线骨髓原始细胞比例、AML类型和美国国立综合癌症网络（NCCN）风险分层组匹配病例和对照，我们比较了IC联合维奈克拉或HMAs与单纯IC治疗新诊断AML一个周期后的缓解率（完全缓解[CR]、CR/CRi、客观缓解率[ORR]和微小残留病阴性）及血液学不良事件。
联合维奈克拉可提高IC的CR/CRi（IC联合维奈克拉为83.8%，单纯IC为66.1%，P = 0.029）。维奈克拉加入IA方案未提高IA方案的CR/CRi（IA联合维奈克拉为76.9%，单纯IA为76.2%，P = 0.986）。加入HMAs不仅可提高IC的CR/CRi（IC联合HMAs为85.3%，单纯IC为65.4%，P = 0.002），还可提高IA方案的CR/CRi（IA联合HMAs为91.3%，单纯IA为70.0%，P = 0.034）。加入HMAs可提高IC后有不良突变（FLT3、IDH1/2、K/NRAS）患者的CR/CRi。加入维奈克拉和HMAs均延长了粒细胞缺乏症和血小板减少症的持续时间。
加入HMAs可能提高包括IA在内的IC的CR/CRi。加入维奈克拉可能无法提高IA的CR/CRi。现在有必要进行一项设计良好的前瞻性随机对照研究。
