阿扎胞苷联合Venetoclax治疗老年急性髓系白血病患者的疗效与安全性观察
曹锦霞 （ 常德市第一人民医院 血液科 ）
胡 彬 （ 常德市第一人民医院 血液科 ）
易利平 （ 常德市第一人民医院 血液科 ）
李天琪 （ 常德市第一人民医院 血液科 ）
王 俊 （ 常德市第一人民医院 血液科 ）
https://doi.org/10.37155/2661-4766-0306-35Abstract
目的： 观察阿扎胞苷联合Venetoclax方案治疗老年急性髓系白血病患者的疗效和安全性。 方法： 收集本 院2019年1月－ 2021年12月老年急性髓系白血病患者21 例。根据治疗方法分为两组：实验组（ 10例）和对照组（ 11 例）。实验组：阿扎胞苷联合Venetoclax方案治疗；对照组：蒽环类联合标准方案，均治疗1个疗程，比较两组的① 复合完全缓解率（ CR CRi）；②总反应率（ ORR）；③1疗程后MRD阴性率；④患者粒细胞缺乏时间、输注红细 胞量及输血小板量。 结果： 实验组的CR CRi率和ORR率差异无统计学意义（ P > 0.05）（ 70.0% ﹠ 54.5%） (90.0%﹠ 72.7%)，实验组： 1疗程后MRD阴性率与对照组的差异无统计学意义（ P > 0.05）；实验组粒细胞缺乏时间明显短于对 照组（ P < 0.05），实验组输注红细胞量、血小板量显著少于对照组（ P < 0.05）。 结论： 阿扎胞苷联合Venetoclax方案 治疗老年急性髓系白血病患者有一定疗效，耐受性好，安全性更高，是适合治疗老年急性AML的方案。
Keywords
阿扎胞苷;Venetoclax;老年急性髓系白血病;疗效;安全性Full Text
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Oncology. J Natl Compr Canc Netw, 2017. 15(7): p. 926-957.
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decitabine or azacitidine in treatment-naive, elderly patients
with acute myeloid leukemia. Blood, 2019. 133(1): p. 7-17.
[4]Chen, S., et al., Bioinformatics Analysis Identifies
Key Genes and Pathways in Acute Myeloid Leukemia
Associated with DNMT3A Mutation. Biomed Res Int, 2020.
2020: p. 9321630.
[5]Bullinger, L., K. Dohner and H. Dohner, Genomics
of Acute Myeloid Leukemia Diagnosis and Pathways. J Clin
Oncol, 2017. 35(9): p. 934-946.
[6]Leonard, J.P., P. Martin and G.J. Roboz, Practical
Implications of the 2016 Revision of the World Health
Organization Classification of Lymphoid and MyeloidNeoplasms and Acute Leukemia. J Clin Oncol, 2017. 35(23):
p. 2708-2715.
[7]Gardin, C., et al., Postremission treatment of elderly
patients with acute myeloid leukemia in first complete
remission after intensive induction chemotherapy: results
of the multicenter randomized Acute Leukemia French
Association (ALFA) 9803 trial. Blood, 2007. 109(12): p.
5129-35.
[8]Pautas, C., et al., Randomized study of intensified
anthracycline doses for induction and recombinant
interleukin-2 for maintenance in patients with acute myeloid
leukemia age 50 to 70 years: results of the ALFA-9801 study.
J Clin Oncol, 2010. 28(5): p. 808-14.
[9]Liu, X., et al., Dual Growth Factor (rhTPO + G-CSF)
and Chemotherapy Combination Regimen for Elderly Patients
with Acute Myeloid Leukemia: A Phase II Single-Arm
Multicenter Study. Int J Gen Med, 2021. 14: p. 6093-6099.
[10]Qian, S.X., et al., Effect of low-dose cytarabine
and aclarubicin in combination with granulocyte colonystimulating factor priming (CAG regimen) on the outcome
of elderly patients with acute myeloid leukemia. Leuk Res,
2007. 31(10): p. 1383-8.
[11]Li, J., et al., Efficacy and safety of decitabine
in combination with G-CSF, low-dose cytarabine and
aclarubicin in newly diagnosed elderly patients with acute
myeloid leukemia. Oncotarget, 2015. 6(8): p. 6448-58.
[12]Boddu, P.C., et al., Characteristics and outcomes
of older patients with secondary acute myeloid leukemia
according to treatment approach. Cancer, 2017. 123(16): p.
3050-3060.
[13]Kantarjian, H., et al., Results of intensive
chemotherapy in 998 patients age 65 years or older with acute
myeloid leukemia or high-risk myelodysplastic syndrome:
predictive prognostic models for outcome. Cancer, 2006.
106(5): p. 1090-8.
[14]Jones, P.A., Functions of DNA methylation: islands,
start sites, gene bodies and beyond. Nat Rev Genet, 2012.
13(7): p. 484-92.
[15]Morgan, A.E., T.J. Davies and A.M. Mc, The role of
DNA methylation in ageing and cancer. Proc Nutr Soc, 2018.
77(4): p. 412-422.
[16]Thomas, D. and R. Majeti, Biology and relevance
of human acute myeloid leukemia stem cells. Blood, 2017.
129(12): p. 1577-1585.
[17]Dombret, H., et al., International phase 3 study of
azacitidine vs conventional care regimens in older patients
with newly diagnosed AML with >30% blasts. Blood, 2015.
126(3): p. 291-9.
[18]Fenaux, P., et al., Azacitidine prolongs overall
survival compared with conventional care regimens in elderly
patients with low bone marrow blast count acute myeloid
leukemia. J Clin Oncol, 2010. 28(4): p. 562-9.
[19]Pan, R., et al., Selective BCL-2 inhibition by ABT-
199 causes on-target cell death in acute myeloid leukemia.
Cancer Discov, 2014. 4(3): p. 362-75.
[20]Konopleva, M. and A. Letai, BCL-2 inhibition in
AML: an unexpected bonus? Blood, 2018. 132(10): p. 1007-
1012.
[21]Konopleva, M., et al., Efficacy and Biological
Correlates of Response in a Phase II Study of Venetoclax
Monotherapy in Patients with Acute Myelogenous Leukemia.
Cancer Discov, 2016. 6(10): p. 1106-1117.
[22]DiNardo, C.D., et al., Safety and preliminary
efficacy of venetoclax with decitabine or azacitidine in elderly
patients with previously untreated acute myeloid leukaemia:
a non-randomised, open-label, phase 1b study. Lancet Oncol,
2018. 19(2): p. 216-228
Copyright © 2022 曹锦霞,胡 彬,易利平,李天琪,王 俊
Publishing time:2021-12-31
This work is licensed under a Creative Commons Attribution 4.0 International License
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