应用计算生物组学模型预判难治性急性髓系白血病治疗反应1例并文献复习

Computational omics biology model predicts therapy response of refractory acute myeloid leukemia:report of 1 case and review of literature

目的探讨计算生物组学模型(CBM)在难治性急性髓系白血病(AML)患者治疗中的价值。方法回顾性分析2018年11月收治的1例采用由Cellworks肿瘤治疗应答指数(TRI)检测预测的个性化治疗方案治疗的难治性AML患者临床资料,总结诊疗过程及治疗效果,并复习AML治疗中CBM应用的相关文献。结果患者为43岁女性,伴t(6;11)(q27;q23),确诊后经2次诱导治疗均失败且化疗耐受性差。2019年3月行Cellworks TRI检测,预测最佳方案为克拉屈滨+曲美替尼+阿糖胞苷三药联合方案。患者采用该方案治疗1个疗程后复查达到完全缓解且微小残留病阴性,后成功实施亲源半相合异基因造血干细胞移植术。2020年11月疾病复发,无病生存19个月;2021年4月死亡,总生存时间为28.5个月。结论基于CBM的TRI检测为难治性AML患者提供了新的治疗思路,依据基因组学预测出的个性化治疗建议可能改善患者生存。

Objective To investigate the value of computational omics biology model(CBM)in treatment of refractory acute myeloid leukemia(AML)patients.Methods The clinical data of a refractory AML patient who received personalized therapy regimen predicted by Cellworks tumor response index(TRI)test in November 2018 were retrospectively analyzed.The diagnosis,treatment and the therapeutic efficacy were summarized.The literature related to CBM in AML was reviewed.Results The patient,a 43-year-old female,was diagnosed as AML accompanied with t(6;11)(q27;q23).She failed to respond after 2 courses of induction therapy,and had poor tolerance of chemotherapy.And then the Cellworks TRI test recommended the 3-drug combination regimen of cladribine,trametinib and cytarabine as the optimal chemotherapy regimen.After 1 course of treatment,the patient achieved complete remission and minimal residual disease negative.After remission,the patient successfully underwent haplo-hematopoietic stem cell transplantation.She experienced a prolonged disease-free survival of 19 months and relapsed in November 2020,and passed away in April 2021.The overall survival time was 28.5 months.Conclusions Cellworks TRI test based on CBM provides a new therapeutic approach for refractory AML patients,and its personalized treatment regimen based on genomics may improve the survival of patients.