VA方案与地西他滨联合CAG方案治疗不适合标准化疗的急性髓系白血病的疗效比较

Comparison of the efficacy of venetoclax combined azacitidine regimen and combination of decitabine and CAG regimen in acute myeloid leukemia unfit for standard chemotherapy

目的:比较VA方案、地西他滨联合CAG方案治疗新诊断的不适合标准化疗(unfit for standard chemotherapy,UNFIT)急性髓系白血病(acute myeloid leukemia,AML)的疗效。方法:收集2019年07月至2022年07月我院新诊断UNFIT AML病例,回顾性分析两种方案完全缓解率(CR)、复合完全缓解率(cCR)、总反应率(ORR)、可检测残留病(MRD)阴性率、无事件生存率(EFS)、总体生存率(OS)、不良反应发生率,比较不同亚组疗效差异。结果:VA方案ORR率显著优于地西他滨联合CAG方案。IDH1/2突变患者应用VA方案CR率、cCR率、ORR率显著优于地西他滨联合CAG方案。DNMT3A突变患者应用VA方案MRD阴性率显著高于地西他滨联合CAG方案。VA方案在FLT3突变亚组中获得较地西他滨联合CAG方案更长的OS。结论:VA方案ORR率显著优于地西他滨联合CAG方案。IDH1/2突变、DNMT3A突变、FLT3突变患者应用VA方案较地西他滨联合CAG方案更加获益。

Objective:To compare the efficacy and safety of venetoclax combined with azacitidine(VA)regimen and combination of decitabine(DAC)and CAG(cytosine arabinoside+aclacinomycin+granulocyte colony stimulating factor)regimen in newly diagnosed acute myeloid leukemia(AML)patients who were unfit for intensive chemotherapy.Methods:Clinical data of newly diagnosed AML patients who were unfit for intensive chemotherapy admitted to our hospital from 2019.07 to 2022.07 were collected.The complete response rate(CR),composite complete response rate(cCR),overall response rate(ORR),measurable residual disease(MRD),event-free survival rate(EFS),overall survival rate(OS),and incidence of adverse events were analyzed retrospectively.The efficacy among different subgroups were assessed.Results:The ORR rate of VA regimen was significantly higher than combination of DAC and CAG regimen.IDH1/2 mutation patients in VA regimen had significantly higher rate of CR,cCR and ORR than those in combination of DAC and CAG regimen.Patients with DNMT3A mutation showed significantly higher MRD negative rate in VA regimen than those received combination of DAC and CAG regimen.Patients with FLT3 mutation in VA regimen had longer OS than combination of DAC and CAG regimen.Conclusion:VA regimen demonstrated significantly superior ORR rate than combination of DAC and CAG regimen.Patients with IDH1/2,DNMT3A or FLT3 mutation were likely to benefit more in VA regimen than in combination of DAC and CAG regimen.