维奈克拉联合阿扎胞苷治疗伴播散性镰刀菌感染的AML一例

Combined use of venetoclax and azacitidine in treatment of acute myeloid leukemia complicated with disseminated Fusarium infection:a case report

急性髓系白血病(AML)是起源于造血干/祖细胞的恶性克隆性疾病。化学治疗是其主要的治疗方法,若部分初治患者应用标准方案治疗2个疗程仍无效,即为难治性AML。该文报道1例经维奈克拉联合阿扎胞苷治疗的伴播散性镰刀菌感染的难治性AML患者,其被诊断为AML(M5a),存在DNMT3A、IDH2、BCOR基因突变,中危组。经标准剂量IA方案(去甲氧柔红霉素+阿糖胞苷)治疗无效,追加高三尖杉酯碱再次诱导治疗仍无效。其后改用维奈克拉联合阿扎胞苷方案治疗,患者疾病缓解,并再次用原方案巩固治疗3次,达完全缓解。患者第1次化学治疗后出现反复发热,四肢紫红色硬结伴中央坏死,皮下可见液性包块,活组织病理学检查等提示镰刀菌感染,针对镰刀菌感染采用两性霉素B联合伏立康唑抗真菌治疗,经治疗后患者播散性镰刀菌感染得到控制。该例提示,维奈克拉联合阿扎胞苷方案治疗难治性AML缓解率高,播散性镰刀菌感染是AML化学治疗后少见的致死性并发症,早期明确诊断并给予有效的抗真菌治疗是提高患者生存率的有效手段。

Acute myeloid leukemia(AML)is a malignant clonal disease originating from hematopoietic stem/progenitor cells.Chemotherapy is the main treatment.If not effectively treated after 2 courses of standard treatment,these patients can be diagnosed with refractory AML.In this article,a case of refractory AML complicated with disseminated Fusarium infection receiving combined treatment of venetoclax and azacitidine was reported.The patient was diagnosed with AML(M5 a)with DNMT3 A,IDH2 and BCOR mutations,classified in the moderate group.Standard dose of IA regimen(deoxydaunorubicin+cytarabine)was ineffective,and additional homoharringtonine induction therapy remained ineffective.Subsequently,combined use of venetoclax and azacitidine was adopted and the severity of disease was alleviated.Complete remission was achieved after three cycles of venetoclax combined with azacitidine consolidation therapy.After the first chemotherapy,the patient presented with recurrent fever,purple induration with central necrosis in the upper and lower limbs,and visible subcutaneous liquid mass.Pathological examination suggested Fusarium infection.After amphotericin B combined with voriconazole as antifungal therapy,disseminated Fusarium infection was effectively controlled.This case prompts that combined use of venetoclax and azacitidine yields high remission rate in the treatment of refractory AML.Disseminated Fusarium infection is a rare fatal complication in AML patients after chemotherapy.Early diagnosis and effective antifungal treatment are effective interventions to improve the survival rate of patients.