以维奈克拉为基础的联合化学治疗方案治疗急性髓系白血病疗效观察  

Efficacy of venetoclax-based chemotherapy in the treatment of acute myeloid leukemia

作　　者：沈立云[1] 杨华[1] 张红梅 韩娜[1] SHEN Liyun;YANG Hua;ZHANG Hongmei;HAN Na(Department of Hematology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan Province,China)

机构地区：[1]郑州大学第二附属医院血液科,河南郑州450000

出　　处：《新乡医学院学报》2025年第4期310-314,共5页Journal of Xinxiang Medical University

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20210422)。

摘　　要：目的探讨以维奈克拉为基础的化学治疗方案对急性髓系白血病(AML)的治疗效果。方法选择2022年11月至2023年12月郑州大学第二附属医院收治的51例AML患者为研究对象,按照治疗方法将患者分为对照组(n=25)与观察组(n=26)。对照组患者口服维奈克拉片,第1天给予100 mg,每日1次;第2天给予200 mg,每日1次;第3~21天给予400 mg,每日1次;所有患者连续用药21 d。观察组患者在对照组治疗基础上给予甲基化药物(HMA)阿扎胞苷皮下注射治疗,每日75 mg·m^(-2),连续给药7 d;合并FMS样酪氨酸激酶3(FLT3)突变患者给予FLT3抑制剂吉瑞替尼口服,每日1次,每次120 mg,连续治疗21 d。比较2组AML患者的疗效[客观缓解率(ORR)]、生存情况[总生存期(OS)、无进展生存期(PFS)]、用药不良反应发生率及免疫功能指标水平。结果治疗后,观察组患者的ORR显著高于对照组(P<0.05);观察组合并FLT3突变患者的ORR显著高于对照组(P<0.05)。观察组患者的OS及PFS显著长于对照组(P<0.05)。治疗期间,观察组5例(21.74%)患者发生胃肠道反应,1例(4.38%)发生白细胞减少,1例(4.38%)发生血小板减少,2例(8.70%)发生肝功能异常,不良反应发生率为39.13%(9/23);对照组3例(13.04%)发生胃肠道反应,1例(4.38%)发生血小板减少,不良反应发生率为17.39%(4/23)。对照组与观察组患者的不良反应发生率比较差异无统计学意义(χ^(2)=2.681,P>0.05)。治疗前,2组患者的CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)比较差异无统计学意义(P>0.05);治疗后,2组患者CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)显著高于治疗前,CD8^(+)显著低于治疗前(P<0.05);治疗后,2组患者的CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)比较差异无统计学意义(P>0.05)。结论以维奈克拉为基础联合HMA治疗AML患者的疗效更高,能有效延长患者生存期,联合FLT3抑制剂对合并FLT3突变患者能起到更显著的疗效,且用药安全性较高。Objective To investigate the effect of venetoclax-based chemotherapies in the treatment of acute myeloid leukemia(AML).Methods A total of 51 AML patients admitted to the Second Affiliated Hospital of Zhengzhou University from November 2022 to December 2023 were selected as study subjects,they were then divided into a control group(n=25)and an observation group(n=26)by the treatment method.Patients in the control group were given oral venetoclax tablets,100 mg once on the first day,200 mg once on the second day,and 400 mg once a day from the third to the twenty-first day.All patients in the control group received continuous medication for 21 days.Patients in the observation group were all treated with venetoclax tablets in combination with a demethylating agent(HMA)or an FMS-like tyrosine kinase 3(FLT3)inhibitor.The administration method and dosage of venetoclax tablets were the same as those in the control group.Additionally,they were treated with subcutaneous injections of HMA azacitidine,75 mg·m^(-2)daily for consecutive 7 days.Patients with FLT3 mutations were given oral FLT3 inhibitors gilteritinib,120 mg once daily for consecutive 21 days.The therapeutic effect[objective response rate(ORR)],survival status[overall survival(OS),progression-free survival(PFS)],the incidence of adverse reactions and immune function indicators were compared between the two groups.Results The ORR of patients in the observation group were significantly higher than those in the control group after treatment(P<0.05),and the ORR of patients with FLT3 mutations in the observation group were significantly higher than those in the control group after treatment(P<0.05).The OS and PFS of patients in the observation group were significantly longer than those in the control group(P<0.05).During the treatment period,gastrointestinal reactions,leukopenia,thrombocytopenia,and abnormal liver function were observed in 5 patients(21.74%),1 patient(4.38%),1 patients(4.38%)and 2 patients(8.70%)in the observation group,respectively.The adverse reac

关 键 词：维奈克拉 急性髓系白血病 生存情况 去甲基化药物 

分 类 号：R733.71[医药卫生—肿瘤]