应用维奈克拉桥接清髓性预处理方案的挽救性异基因造血干细胞移植治疗原发诱导治疗失败的急性髓系白血病一例  

Salvage allogeneic hematopoietic stem cell transplantation under venetoclax bridging myeloablative preconditioning regimen for an acute myeloid leukemia patient with primary induction therapy failure

作　　者：周海侠[1] 薛胜利[1] 徐明珠[1] 陈丽韵[1] 钱崇升 刘吟[1] 孙爱宁[1] 吴德沛[1] Zhou Haixia;Xue Shengli;Xu Mingzhu;Chen Liyun;Qian Chongsheng;Liu Yin;Sun Aining;Wu Depei(Department of Hematology,the First Affiliated Hospital of Soochow University,National Center for Clinical Research on Hematological Diseases,Key Laboratory of Thrombosis and Hemostasis of Ministry of Health,Jiangsu Institute of Hematology,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院血液科,江苏省血液研究所,卫生部血栓与止血重点实验室,国家血液系统疾病临床医学研究中心,江苏苏州215006

出　　处：《白血病．淋巴瘤》2021年第9期534-537,共4页Journal of Leukemia & Lymphoma

基　　金：国家自然科学基金(81970138);国家血液系统疾病临床医学研究中心转化研究课题(2020ZKMB05);江苏省青年医学人才项目(QNRC2016719);姑苏卫生人才项目(GSWS2019007)。

摘　　要：目的探讨维奈克拉在难治急性髓系白血病(AML)患者移植中的应用。方法回顾性分析2020年3月苏州大学附属第一医院收治的1例诱导治疗失败后使用维奈克拉和去甲基化药物桥接清髓性预处理方案后行异基因造血干细胞移植(allo-HSCT)的难治AML患者诊治过程。结果患者,女性,28岁,诊断为难治AML。初始给予IA(去甲氧柔红霉素+阿糖胞苷)(3+7)方案诱导化疗未缓解,CLAG(克拉屈滨+阿糖胞苷+粒细胞集落刺激因子)方案再诱导化疗未缓解,使用维奈克拉与去甲基化药物桥接清髓性预处理方案化疗后,进行挽救性单倍体allo-HSCT。复查骨髓缓解,植入成功,随访100 d,持续缓解,无移植并发症发生。结论对于原发诱导治疗失败的难治AML,使用维奈克拉与去甲基化药物桥接清髓性预处理可作为挽救性allo-HSCT的优选方案。Objective To explore the application of venetoclax in transplantation of patients with refractory acute myeloid leukemia(AML).Methods The diagnosis and treatment process of a patient with refractory AML who underwent allogeneic hematopoietic stem cell transplantation(allo-HSCT)under venetoclax and hypomethylating agents bridging myeloablative preconditioning regimen after induction therapy failure in the First Affiliated Hospital of Soochow University in March 2020 were retrospectively analyzed.Results The patient was a 28-year-old female who was diagnosed with refractory AML.The patient was initially given induction chemotherapy with IA(idarubicin+cytarabine)(3+7)regimen,but the disease did not relieve,then the induction chemotherapy with CLAG(cladribine+cytarabine+granulocyte colony stimulating factor)regimen was given,but the disease still did not relieve.After chemotherapy with venetoclax and hypomethylating agents bridging myeloablative preconditioning regimen,salvage haploid allo-HSCT was performed.Re-examination of bone marrow showed remission,and implantation was successful.The patient was followed up for 100 days and had sustained remission,and no transplantation complications occurred.Conclusion For refractory AML patients who have failed primary induction therapy,the use of venetoclax and hypomethylating agents bridging myeloablative preconditioning regimen can be used as a preferred solution for salvage allo-HSCT.

关 键 词：白血病 髓样 急性 维奈克拉 诱导化疗 挽救疗法 造血干细胞移植 

分 类 号：R733.71[医药卫生—肿瘤]