Clinical analysis of azacitidine combined with venetoclax in the treatment of elderly patients with acute myeloid leukemia
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摘要: 目的 分析阿扎胞苷联合Bcl-2抑制剂维奈克拉治疗老年急性髓系白血病(AML)的临床疗效。方法 回顾性分析2018年5月—2021年8月本院收治的68例老年AML患者的临床资料，根据治疗方案不同分为2组：使用阿扎胞苷联合维奈克拉治疗的患者设为观察组(30例); 使用阿扎胞苷联合半量预激方案化疗的患者设为对照组(38例)。分别对2组患者的疗效、化疗不良反应进行比较。结果 2个疗程诱导治疗结束后进行疗效评价，观察组的完全缓解率和总有效率均显著高于对照组(63.3% vs 36.8%、76.6% vs 52.6%，P< 0.05);观察组血小板恢复时间及中性粒细胞恢复时间均明显短于对照组(P< 0.05);2组患者治疗后CD3+T淋巴细胞、CD4+T淋巴细胞计数均明显低于治疗前(P< 0.05)，组间比较差异无统计学意义。中位随访时间18(5~25)个月，观察组中位生存时间为17.00(95%CI13.53~20.46)个月，对照组中位生存时间为12.00(95%CI10.00~14.00)个月，观察组中位生存时间较对照组明显延长(P< 0.05)。血液学不良反应方面，2组患者间Ⅲ~Ⅳ级中性粒细胞减少发生率、Ⅲ~Ⅳ级血小板减少发生率和Ⅲ~Ⅳ级中性粒细胞减少伴感染发生率比较差异无统计学意义。非血液学不良反应方面，2组患者间胃肠道不良反应发生率比较差异无统计学意义; 观察组出现1例肿瘤溶解综合征，经水化、碱化等综合治疗后好转，诱导化疗期间无患者死亡。结论 与阿扎胞苷联合半量预激方案化疗比较，阿扎胞苷联合维奈克拉方案提高了老年AML患者的完全缓解率和总有效率，缩短了化疗后血小板及中性粒细胞的恢复时间，明显延长了患者的中位生存时间，且未明显增加血液学及非血液学不良反应，老年患者可耐受，具有明显优势。Abstract: Objective To analyze the clinical efficacy of azacitidine combined with Bcl-2 inhibitor venetoclax in the treatment of elderly acute myeloid leukemia(AML).Methods The clinical data of 68 elderly patients with AML admitted to our hospital from May 2018 to August 2021 were retrospectively analyzed, and they were divided into two groups according to different treatment regimens. Patients treated with azacitidine combined with venetoclax were set as the observation group(30 cases), and patients treated with azacitidine combined with half-dose pre-excitation chemotherapy were set as the control group(38 cases). The curative effects and adverse events of chemotherapy were compared between the two groups.Results After two courses of induction therapy, the complete remission rate and total effective rate in the observation group were significantly higher than those in the control group(63.3% vs 36.8%, 76.6% vs 52.6%,P< 0.05). The platelet recovery time and neutrophil recovery time in the observation group were significantly shorter than those in the control group(P< 0.05). After treatment, the counts of CD3+T lymphocytes and CD4+T lymphocytes in the two groups were significantly lower than those before treatment(P< 0.05), and there was no significant difference between the two groups. The median follow-up time was 18(5-25) months. The median survival time in the observation group was 17.00(95%CI13.53-20.46) months, which was significantly higher than that of 12.00(95%CI10.00-14.00) months in the control group(P< 0.05). In terms of hematological adverse events, there was no significant difference in the incidence of grade Ⅲ-Ⅳ neutropenia, grade Ⅲ-Ⅳ thrombocytopenia, and grade Ⅲ-Ⅳ neutropenia with infection between the two groups. In terms of non-hematological adverse events, there was no significant difference in the incidence of gastrointestinal adverse events between the two groups. There was one case of tumor lysis syndrome in the observation group, which improved after hydration, alkalization and other comprehensive treatment. No patient died during the induction chemotherapy.Conclusion Compared with azacytidine combined with half-dose pre-excitation chemotherapy, azacytidine combined with venetoclax chemotherapy can improve the complete remission rate and total effective rate of elderly patients with AML, shorten the recovery time of platelets and neutrophils after chemotherapy, significantly prolong the median survival time of patients, and does not increase the hematological and non-hematological adverse events. Elderly patients can tolerate it, which has obvious advantages.
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Key words:
- acute myeloid leukemia /
- elderly /
- Bcl-2 inhibitor /
- venetoclax /
- azacitidine
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表 1 2组患者基本临床资料比较
临床特征 观察组(30例) 对照组(38例) P 男∶女/例 18∶12 24∶14 0.79 年龄/岁 68.13±7.42 67.82±5.55 0.83 ECOG评分/例(%) 0.85 1 9(30.0) 13(34.2) 2 13(43.3) 17(44.7) 3 8(26.7) 8(21.1) FAB分型/例(%) 0.85 M1 2(6.7) 1(2.6) M2 16(53.3) 23(60.5) M4 2(6.7) 3(7.9) M5 7(23.3) 9(23.7) M6 3(10.0) 2(5.3) 分子遗传学/例(%) 0.81 低危 9(30.0) 12(31.6) 中危 11(36.7) 16(42.1) 高危 10(33.3) 10(26.3) 白细胞计数/(×109·L-1) 5.21(2.80~15.70) 8.50(2.90~21.30) 0.26 骨髓原始细胞比例/% 42.82±19.39 42.10±17.91 0.86 
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表 2 2组治疗前后免疫功能指标变化
x±S 组别 CD3+T淋巴细胞/% CD4+T淋巴细胞/% 治疗前 治疗后 治疗前 治疗后 观察组(30例) 66.1±13.4 56.1±12.71) 47.4±11.1 41.7±10.31) 对照组(38例) 67.5±12.3 58.2±11.61) 50.0±9.9 42.9±7.41) 与同组治疗前比较，1)P < 0.05。
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