维奈克拉联合阿扎胞苷与地西他滨联合DAG/IAG方案治疗新诊断急性髓系白血病的效果比较

Efficacy of venetoclax combined with azacytidine and decitabine combined with DAG/IAG regimen in the treatment of newly diagnosed acute myeloid leukemia

目的探讨维奈克拉联合阿扎胞苷与地西他滨(DAC)联合预激方案(DAG/IAG)治疗新诊断急性髓系白血病(AML)的效果及安全性。方法回顾性分析新诊断的AML40例患者病历资料,其中21例采用DAC联合DAG/IAG方案治疗为A组,另19例采用维奈克拉联合阿扎胞苷方案治疗为B组。所有病例经1个疗程化疗后评估疗效和安全性,获得完全缓解(CR)或部分缓解(PR)者均重复原方案化疗,无效者换其他方案。分析2组方案的疗效及安全性。结果2组患者在基线年龄、性别比例、危险度分层等方面差异均无统计学意义(P>0.05)。在诱导缓解治疗中,2组间反应比较,A组61.90%(13/21)患者达有效(OR,OR为CR+PR),38.09%(8/21)患者达未缓解(NR);B组89.47%(17/19)患者达OR,10.53%(2/19)患者达NR;B组缓解率优于A组,2组间差异有统计学意义(P<0.05)。A组不良反应发生率略高于B组,但均差异无统计学意义(P>0.05)。在随访期内,A组患者95.24%(20/21)疾病进展,中位无进展生存期5个月,1年无进展生存(PFS)率15.38%。B组患者31.58%(6/19)进展,1年PFS率58.56%。B组无进展生存期优于A组,2组间差异有统计学意义(P<0.05)。结论维奈克拉联合阿扎胞苷治疗不适合接受标准化疗的AML患者,诱导缓解率、无进展生存期均优于DAC联合DAG/IAG。

Objective To explore the efficacy and safety of venetoclax combined with azacytidine and decitabine combined with DAG/IAG regimen in the treatment of newly diagnosed acute myeloid leukemia.Methods Forty patients with newly diagnosed acute myeloid leukemia(AML),In Group A,21 patients were treated with DAC combined DAG/IAG regimen,the other 19 patients were treated with venetoclax combined with Azacytidine regimen as group B.After one course of chemotherapy,all patients were evaluated for efficacy and side effects.Those who achieved remission(CR)or partial remission(PR)were treated with the same chemotherapy regimen,and those who did not received the other regimens.The clinical efficacy and safety of the two groups were analyzed statistically.Results There were no significant differences in baseline age,sex ratio,and risk stratification between the two groups(P>0.05).In induction therapy,61.90%(13/21)in Group A achieved OR and 38.09%(8/21)had no NR.In Group B,89.47%(17/19)achieved OR and 10.53%(2/19)had NR.Group B was superior to Group A,and there was significant difference between the two groups(P<0.05).The incidence of side effects in Group A was slightly higher than that in Group B,but there was no significant difference(P>0.05).During the follow-up period,95.24%(20/21)in Group A developed the disease,and the median progression-free survival was 5 months,1-year progression-free survival rate 15.38%.In Group B,31.58%(6/19)of the patients progressed,and the median progression-free survival did not achieved during follow-up,1-year PFS rate 58.56%.The survival time without progression in Group B was better than that in Group A,and there was significant difference between the two groups(P<0.05).Conclusions The induction response rate,progression-free survival of patients with AML who are unfit for conventional chemotherapy treated with venetoclax combined with azacytidine are better than those with DAC combined with DAG/IAG.