VIALE-A改良方案治疗高龄中高危骨髓增生异常综合征患者效果与安全性  

Efficacy and safety of modified VIALE-A regimen for treatment of elderly patients with intermediate or high risk myelodysplastic syndromes

作　　者：孙启鑫[1] 温真真[2] 陈晓燕[3] 王阿慧[4] 陈桂萍[1] 赵紫媛 朱志刚[1] Sun Qixin;Wen Zhenzhen;Chen Xiaoyan;Wang Ahui;Chen Guiping;Zhao Ziyuan;Zhu Zhigang(Department of Geriatric Hematology and Oncology,Guangzhou First People's Hospital,Guangzhou 510180,China;Blood Purification Center,Guangzhou First People's Hospital,Guangzhou 510180,China;Department of Hematology,Guangzhou First People's Hospital,Guangzhou 510180,China;Department of Clinical Laboratory,Guangzhou First People's Hospital,Guangzhou 510180,China)

机构地区：[1]广州市第一人民医院老年血液肿瘤科,广州510180 [2]广州市第一人民医院血液净化中心,广州510180 [3]广州市第一人民医院血液内科,广州510180 [4]广州市第一人民医院检验科,广州510180

出　　处：《白血病．淋巴瘤》2024年第8期462-465,共4页Journal of Leukemia & Lymphoma

基　　金：广州市医学重点学科项目(ZDXK202103)。

摘　　要：目的探讨VIALE-A改良方案治疗高龄(>75岁)中高危骨髓增生异常综合征(MDS)患者的临床疗效与安全性。方法回顾性病例系列分析。收集2021年5月至2023年8月采用VIALE-A改良方案(阿扎胞苷每天75 mg/m2第1天至第7天+维奈克拉每天200 mg第8天至第28天)持续治疗的7例>75岁MDS患者临床资料, 患者依据世界卫生组织2016分型标准进行诊断, 依据修订的国际预后评分系统判定为中高危。分析患者疗效及常见不良反应, 采用Kaplan-Meier法进行生存分析。结果 7例患者中, 女性5例, 男性2例;中位年龄[M(Q1, Q3)]84岁(80岁, 90岁)。1例患者初治失败, 其余6例经1~2个疗程VIALE-A改良方案诱导治疗达骨髓完全缓解或完全缓解;中位治疗疗程数为10个(4个, 16个)。至2023年12月31日随访截止, 中位随访10个月(5个月, 18个月), 中位总生存时间18个月(95%CI:0~39个月)。诱导期7例患者均发生3~4级骨髓抑制, 以粒细胞减少常见, 持续时间7~10 d;维持治疗累计64个疗程中, 54个(84%)疗程发生1~3级骨髓抑制;非血液学不良反应轻微;累计73个疗程中无治疗中断发生。结论 VIALE-A改良方案治疗高龄中高危MDS疗效尚可, 不良反应可控。Objective To explore the efficacy and safety of the modified VIALE-A regimen in the treatment of elderly(>75 years old)patients with intermediate or high risk myelodysplastic syndromes(MDS).Methods A retrospective case series analysis was conducted.Clinical data were collected from 7 MDS patients aged>75 years who were continuously treated with the modified VIALE-A regimen(azacytidine 75 mg/m’per day from day 1 to day 7+venetoclax 200 mg per day from day 8 to day 28)from May 2021 to August 2023,and the patients were diagnosed according to the World Health Organization 2016 staging criteria and were determined to be at intermediate or high risk according to the revised International Prognostic Scoring System.The patients'efficacy and common adverse reactions were analyzed,and the Kaplan-Meier method was used for survival analysis.Results Of the 7 patients,5 were female and 2 were male;the median age[M(Q,Q.)]was 84 years old(80 years old,90 years old).One patient failed the initial treatment,and the remaining 6 achieved complete remission or complete remission in bone marrow after induction therapy with the modified VIALE-A regimen in 1-2 courses.By the follow-up cut-off date of December 31st,2023,the median follow-up was 10 months(5 months,18 months)and the median overall survival time was 18 months(95%Cl:0-39 months).Grade 3-4 myelosuppression occurred in all 7 patients during the induction phase,with granulocytopenia lasting 7-10 d;Of the 64 courses of maintenance treatment,54(84%)had grade 1-3 myelosuppression;non-hematologic adverse reactions were mild;no treatment interruptions occurred in the cumulative 73 courses.Conclusions The modified VIALE-A regimen is moderately efficacious in elderly patients with intermediate or high risk MDS,with controllable adverse reactions.

关 键 词：骨髓增生异常综合征 维奈克拉 阿扎胞苷 治疗结果 不良反应 

分 类 号：R551.3[医药卫生—血液循环系统疾病]