摘要
目的比较维奈克拉联合阿扎胞苷(VA)持续化疗和中大剂量阿糖胞苷(I/HDAC)巩固强化治疗对缓解后转FIT(Fit for standard chemotherapy)状态急性髓系白血病(AML)的疗效及安全性。方法收集2020年8月至2024年1月在河北医科大学第二医院血液科经VA方案诱导治疗后FIT状态患者的缓解后治疗临床资料,回顾性分析VA持续化疗和I/HDAC治疗方案疗效差异,观察指标包括总生存(OS)期、无复发生存(RFS)期、无事件生存(EFS)期,以及化疗相关不良反应发生率。结果共收集69例患者资料,其中VA方案持续治疗组46例,I/HDAC巩固强化化疗组23例。VA组中位OS、RFS、EFS期分别为26.18、24.69、20.34个月,I/HDAC组分别为34.14、30.99、28.42个月,差异均无统计学意义(P值均>0.05)。I/HDAC组中欧洲白血病网(ELN)低危、微小残留病(MRD)阳性、FLT3野生型和IDH1/2突变亚组的中位OS期较VA组中相应亚组延长(P值均<0.05)。VA组3~4级粒细胞减少、3~4级血小板减少及血流感染发生率显著低于I/HDAC组(P值均<0.05)。结论对于ELN低危、MRD阳性、FLT3野生型或IDH1/2突变的缓解后FIT状态AML患者,接受I/HDAC巩固强化化疗可能较持续VA化疗OS期延长。缓解后VA持续化疗安全性优于I/HDAC巩固强化化疗。
ObjectiveTo compare the efficacy and safety of continuous venetoclax combined azacitidine(VA)chemotherapy and intermedium/high-dose cytarabine(I/HDAC)consolidation in patients with acute myeloid leukemia(AML)fit for standard chemotherapy(transform from UNFIT).MethodsClinical data of patients who were fit for standard chemotherapy were collected among those with AML who underwent VA induction in the Department of Hematology,the Second Hospital of Hebei Medical University.The overall survival(OS),relapse-free survival(RFS),event-free survival(EFS),and incidence of adverse events were analyzed retrospectively.ResultsThis study enrolled 69 patients,consisting of 46 cases in the VA group and 23 cases in the I/HDAC group.We revealed the following.①The median OS,RFS,EFS were 26.18,24.69,20.34 months in the VA group,and 34.14,30.99,28.42 months in the I/HDAC group,respectively,with no statistically significant difference(all P>0.05).Median OS of patients who underwent I/HDAC consolidation with European Leukemia Net(ELN)favorable-risk,positive measurable residual disease(MRD),wild type FLT3,or IDH1/2 mutation was significantly longer than those who received VA(P<0.05).②Adverse events rate of grade 3-4 neutropenia,grade 3-4 thrombocytopenia,and bacteremia were significantly lower in the VA group than in the I/HDAC group(P<0.05).ConclusionsI/HDAC consolidation was more likely to help get survival benefits for patients with ELN favorable-risk,positive MRD,wild type FLT3,or IDH1/2 mutation.Continuous VA chemotherapy exhibited superior safety than I/HDAC consolidation.
作者
孙立
张朋朋
任思楣
周楠
李丽媛
王真真
崔伟广
杨帆
罗建民
杨琳
Sun Li;Zhang Pengpeng;Ren Simei;Zhou Nan;Li Liyuan;Wang Zhenzhen;Cui Weiguang;Yang Fan;Luo Jianmin;Yang Lin(Department of Hematology,the Second Hospital of Hebei Medical University,Key Laboratory of Hematology,Shijiazhuang 050000,China;Beijing Hospital,Institute of Geriatric Medicine,National Center for Clinical Laboratories,National Center of Gerontology,Chinese Academy of Medical Sciences,Beijing100730,China)
出处
《中华血液学杂志》
北大核心
2025年第4期343-348,共6页
Chinese Journal of Hematology
基金
京津冀基础研究合作专项项目(H2023206914)
国家血液系统疾病临床医学研究中心转化研究课题(2021WWB07)。
