维奈克拉治疗方案对不适宜接受强化化疗的急性髓系白血病患者血液学恢复及治疗反应的影响

Impact of Venetoclax Treatment Schedule on Hematologic Recovery and Treatment Response in AML Patients Unfit for Intensive Chemotherapy.

作者信息

Schüpbach Anja, Akhoundova Dilara, Bacher Ulrike, Nilius Henning, Hoffmann Michèle, Largiadèr Carlo R, Aebi Yolanda, Hayoz Michael, Kronig Marie-Noëlle, Pabst Thomas

机构信息

Department of Medical Oncology, Inselspital, University of Bern, CH-3010 Bern, Switzerland.

Department of Hematology, Inselspital, University of Bern, CH-3010 Bern, Switzerland.

出版信息

Cancers (Basel). 2025 Mar 28;17(7):1138. doi: 10.3390/cancers17071138.

Abstract

(1) Background: The combination of venetoclax and hypomethylating agents (HMAs) is a standard first-line regimen for acute myeloid leukemia (AML) patients unfit for intensive chemotherapy. Since venetoclax-HMAs are usually administered until progression and delayed hematologic recovery is one of the limiting toxicities, cyclic administration including 7-14-day breaks is recommended. However, whether longer venetoclax schedules lead to higher response rates and how venetoclax pharmacokinetics correlate with toxicity and efficacy remains unclarified. In this single-center retrospective study, we analyzed how venetoclax plasma levels and treatment duration impact hematologic toxicity and treatment responses. (2) Methods: We analyzed the safety and efficacy of venetoclax-HMA combination regimens in a cohort of AML patients unfit for intensive chemotherapy treated at our institution between June 2020 and September 2023. The primary endpoint was the correlation between venetoclax plasma levels or administration schedule with hematologic recovery after the first cycle. Secondary endpoints included the following clinical outcomes: correlation with complete response (CR) status, progression-free survival, and overall survival. (3) Results: Within our cohort of 75 AML patients, we found no correlation between venetoclax plasma peak and trough levels, or venetoclax treatment duration (≤ or >14 days), and hematologic toxicity. Patients receiving shorter venetoclax schedules (≤14 days) had similar CR rates compared to patients treated with longer schedules. (4) Conclusions: Our results suggest that shorter (≤14 days) venetoclax schedules may have no negative impact on tumor responses in AML patients receiving venetoclax and HMA combinations. However, prospective validation studies would be required to confirm these findings.

摘要

(1) 背景:维奈克拉与低甲基化药物(HMAs)联合使用是不适合接受强化化疗的急性髓系白血病(AML)患者的标准一线治疗方案。由于维奈克拉-HMAs通常持续给药直至疾病进展,而血液学恢复延迟是限制毒性之一,因此建议采用包括7 - 14天休息期的循环给药方式。然而,维奈克拉更长的给药方案是否会导致更高的缓解率,以及维奈克拉的药代动力学如何与毒性和疗效相关仍不清楚。在这项单中心回顾性研究中,我们分析了维奈克拉血浆水平和治疗持续时间如何影响血液学毒性和治疗反应。(2) 方法:我们分析了2020年6月至2023年9月在我们机构接受治疗的不适合强化化疗的AML患者队列中维奈克拉-HMA联合方案的安全性和疗效。主要终点是第一个周期后维奈克拉血浆水平或给药方案与血液学恢复之间的相关性。次要终点包括以下临床结果:与完全缓解(CR)状态、无进展生存期和总生存期的相关性。(3) 结果:在我们的75例AML患者队列中,我们发现维奈克拉血浆峰浓度和谷浓度、或维奈克拉治疗持续时间(≤或>14天)与血液学毒性之间无相关性。接受较短维奈克拉给药方案(≤14天)的患者与接受较长给药方案的患者相比,CR率相似。(4) 结论:我们的结果表明,较短(≤14天)的维奈克拉给药方案可能对接受维奈克拉和HMA联合治疗的AML患者的肿瘤反应没有负面影响。然而,需要前瞻性验证研究来证实这些发现。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/113b/11987944/ac11dd8eb55e/cancers-17-01138-g001.jpg

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