含维奈克拉联合方案治疗成年人急性髓系白血病多中心研究  

Multicenter study of venetoclax-based combined regimen in treatment of adult acute myeloid leukemia

作　　者：黄月婷 刘龙 蓝天碧 陈爱珍 吴桂香[4] 李志峰[1] 骆宜茗[1] 赵金涛[1] 周勇[1] 林云 方志鸿[1] 夏维林[4] 余莲[3] 姜义容 徐兵[1] Huang Yueting;Liu Long;Lan Tianbi;Chen Aizhen;Wu Guixiang;Li Zhifeng;Luo Yiming;Zhao Jintao;Zhou Yong;Lin Yun;Fang Zhihong;Xia Weilin;Yu Lian;Jiang Yirong;Xu Bing(Department of Hematology,the First Affiliated Hospital of Xiamen University,Xiamen 361003,China;Department of Hematology,Dongguan People's Hospital,Dongguan 523000,China;Department of Hematology,the First Hospital of Longyan City,Longyan 364000,China;Department of Hematology,Jieyang People's Hospital,Jieyang 522000,China)

机构地区：[1]厦门大学附属第一医院血液科,厦门361003 [2]东莞市人民医院血液科,东莞523000 [3]龙岩市第一医院血液科,龙岩364000 [4]揭阳市人民医院血液科,揭阳522000

出　　处：《白血病．淋巴瘤》2022年第7期397-401,共5页Journal of Leukemia & Lymphoma

基　　金：国家自然科学基金面上项目(81770126);福建省自然科学基金面上项目(2021J011359);福建省自然科学基金青年项目(2020J05307)。

摘　　要：目的探讨含维奈克拉的联合方案治疗成年人急性髓系白血病(AML)的效果。方法回顾性分析2018年12月至2021年5月在厦门大学附属第一医院、东莞市人民医院、龙岩市第一医院和揭阳市人民医院4家血液诊疗中心接受含维奈克拉联合方案治疗的50例成年AML(非急性早幼粒细胞白血病)患者资料,应用不同剂量维奈克拉联合去甲基化药物或小剂量化疗方案,分析疗效及不良反应,采用logistic回归分析影响疗效的相关因素。结果50例AML患者复合完全缓解(CR)率62.0%(31/50),总有效率(ORR)76.0%(38/50);28例患者在第1个疗程结束后达有效[CR+部分缓解(PR)],最迟在接受3个疗程治疗后达有效;初治组28例,复合CR率60.8%(17/28),ORR 78.6%(22/28);复发难治组(RR组)22例,复合CR率63.6%(14/22),ORR 72.7%(16/22),两组ORR比较差异无统计学意义(χ^(2)=0.23,P=0.743)。logistic多因素回归分析结果显示年龄是治疗有效的独立影响因素(OR=8.451,95%CI 1.306~54.697,P=0.025)。维奈克拉治疗的中位持续时间4.5个月(1.1~15.0个月),治疗有效患者16例复发,维持有效的中位时间5个月(1.1~11.0个月)。全部患者均发生不同程度的治疗后骨髓抑制,其次为恶心、呕吐、腹痛等胃肠道反应,全部患者均无因发生骨髓抑制相关并发症而停药>1周。结论含维奈克拉的联合方案治疗AML具有较好疗效,对老年患者减低剂量治疗亦疗效佳,耐受性好。Objective To investigate the efficacy of venetoclax-based combined regimen in treatment of adult patients with acute myeloid leukemia(AML).Methods The data of 50 adult AML(non-acute promyelocytic leukemia)who received venetoclax-based combined regimen in the First Affiliated Hospital of Xiamen University,Dongguan People's Hospital,the First Hospital of Longyan City,Jieyang People's Hospital from December 2018 to May 2021 were retrospectively analyzed.Different doses venetoclax combined with demethylation drugs or low-dose chemotherapy regimen were used to analyze the therapeutic efficacy.The related factors influencing efficacy were analyzed by using logistic regression.Results The composite complete remission(CR)rate of 50 AML patients was 62.0%(31/50),the overall response rate(ORR)was 76.0%(38/50);28 patients achieved effectiveness[CR and partial remission(PR)]after the first cycle and could achieve effectiveness by 3 courses of treatment at the latest.Among 50 patients,28 cases were newly diagnosed AML,the composite CR rate was 60.8%(17/28),ORR was 78.6%(22/28);22 cases were recurrent and relapsed,the composite CR rate was 63.6%(14/22),ORR was 72.7%(16/22);and there was no statistically significant difference of ORR between the both groups(χ^(2)=0.23,P=0.743).Logistic regression multivariate analysis showed age was the only independent influencing factor for the treatment effectiveness(OR=8.451,95%CI 1.306-54.697,P=0.025).The median duration time of patients receiving venetoclax treatment regimen was 4.5 months(1.1-15.0 months);16 cases who had treatment effectiveness finally relapsed,the median time of maintaining effectiveness was 5 months(1.1-11.0 months).Additionally,the common treatment-related adverse reactions included bone marrow suppression after treatment,followed by some gastrointestinal reactions like nausea,vomiting and stomachache.In addition,no patient stopped medication for more than 1 week due to bone marrow suppression related complications.Conclusion Venetoclax-based combined regimen shows

关 键 词：白血病 髓样 急性 治疗结果 维奈克拉 

分 类 号：R733.71[医药卫生—肿瘤]