血小板变化轨迹对初诊AML患者维奈克拉联合阿扎胞苷诱导治疗的疗效预测  

Efficacy Prediction of Platelet Count Trajectories after Induction Therapy with Venetoclax Combined with Azacitidine in Newly Diagnosed AML Patients

作　　者：马倩英 景小蕊 王晗纯 吴惠蓉 成娟 MA Qian-Ying;JING Xiao-Rui;WANG Han-Chun;WU Hui-Rong;CHENG Juan(The First Clinical College of Lanzhou University;Department of Hematology,The First Hospital of Lanzhou University,Lanzhou 730000,Gansu Province,China;Department of Hematology,Donggang Branch of The First Hospital of Lanzhou University,Lanzhou 730000,Gansu Province,China)

机构地区：[1]兰州大学第一临床医学院 [2]兰州大学第一医院血液科,甘肃兰州730000 [3]兰州大学第一医院东岗院区血液科,甘肃兰州730000

出　　处：《中国实验血液学杂志》2025年第2期331-338,共8页Journal of Experimental Hematology

基　　金：甘肃省药品监督管理局科研项目(2021GSMPA009);兰州大学第一医院院内基金科研项目(ZX-62000002-2021-133)。

摘　　要：目的:构建初诊急性髓系白血病(AML)患者维奈克拉联合阿扎胞苷(VA)首次诱导化疗后血小板(PLT)变化轨迹并分析其临床意义。方法:回顾性收集2020年3月至2023年7月就诊于兰州大学第一医院血液科50例接受VA治疗的初诊AML患者临床资料,通过群组化轨迹建模构建诱导化疗后PLT变化轨迹并比较其复合完全缓解(CCR)率、总反应率(ORR)、微小残留病(MRD)阴性率及总生存(OS)率。用Cox比例风险模型评估PLT轨迹和OS之间的关系,用多因素Logistic回归模型分析个体特征对患者PLT轨迹的影响。结果:基于轨迹模型确定两种PLT变化轨迹,分别是PLT缓慢升高组(31例,62.0%)和PLT快速升高组(19例,38.0%)。两组CCR率、ORR率和OS率比较差异均有统计学意义(均P<0.05)。Cox回归结果显示,与PLT缓慢升高组相比,PLT快速升高组与死亡风险降低有关(HR=0.153,95%CI:0.045-0.527,P=0.003)。Logistic回归结果显示,IDH1/2突变(OR=3.908,95%CI:1.023-14.923,P=0.046)和PLT输注(OR=0.771,95%CI:0.620-0.959,P=0.020)是PLT变化轨迹的独立影响因素。结论:初诊AML患者VA诱导治疗后PLT变化轨迹可以作为观察疗效及预后的指标。PLT快速升高是预后的独立保护因素。IDH1/2突变和PLT输注是PLT变化轨迹的独立影响因素。Objective:To investigate platelet count trajectories after induction therapy with venetoclax combined with azacitidine(VA regimen)in newly diagnosed AML patients and further analyze its clinical significance.Methods:Clinical date of 50 newly diagnosed AML patients who received VA treatment from March 2020 to July 2023 in Department of Hematology of the First Hospital of Lanzhou University were retrospectively collected.The platelet trajectories after induction chemotherapy were constructed by using group-based trajectory modeling.To study the association between diverse trajectories of platelet counts and compound complete remission(cCR)rate,overall response rate(ORR),minimal residual disease(MRD)negative rate and overall survival(OS)rate.The Cox proportional hazard model was used to evaluate the relationship between platelet trajectory and OS.The logistic regression was used to analyze the influence of individual characteristics on platelet trajectory.Results:Two platelet trajectories were identified based on the model,including platelet slowly increased group(n=31,62.0%)and platelet rapidly increased group(n=19,38.0%).There were statistically significant differences in cCR rate,ORR and OS rate between platelet slowly increased group and platelet rapidly increased group(all P<0.05).The Cox regression analysis showed that platelet rapidly increased group was associated with a decreased risk of mortality compared with platelet slowly increased group(HR=0.153,95%CI:0.045-0.527,P=0.003).Logistic regression analysis showed that IDH1/2 mutation(OR=3.908,95%CI:1.023-14.923,P=0.046)and platelet transfusion(OR=0.771,95%CI:0.620-0.959,P=0.020)were independent influencing factors of platelet trajectory.Conclusion:The dynamic trajectory of platelet counts in newly diagnosed AML patients who received VA treatment can serve as a significant indicator to observe the efficacy and prognosis.The platelet rapidly increased is an independent protective factor for good prognosis.The IDH1/2 mutation and platelet transfusion are indep

关 键 词：急性髓系白血病 维奈克拉 阿扎胞苷 血小板 群组化轨迹建模 

分 类 号：R733.71[医药卫生—肿瘤]