维奈克拉联合阿伐替尼治疗伴KIT基因突变复发难治急性髓系白血病2例并文献复习

Venetoclax combined with avapritinib for treatment of refractory/relapsed acute myeloid leukemia with KIT gene mutation:report of 2 cases and review of literature

目的探讨维奈克拉联合阿伐替尼治疗伴KIT基因突变复发难治急性髓系白血病(AML)的效果。方法回顾性分析苏州沧浪医院2022年10月及2022年11月收治的2例接受维奈克拉联合阿伐替尼治疗的伴KIT基因突变AML患者的临床资料,并复习相关文献。结果2例患者均为女性,分别为53、17岁,均为高危复发难治AML,均伴KIT基因突变。例1诊断为AML⁃M2,基因检测示ASXL1、KIT、RUNX1基因突变均阳性;患者移植后再次复发,接受维奈克拉联合阿伐替尼治疗达到形态学无白血病状态(MLFS)。例2诊断为AML,检测到RUNX1⁃RUNX1T1(AML1⁃ETO)融合基因及KIT、DX15基因突变;复发后接受维奈克拉联合阿伐替尼方案治疗,明显降低了肿瘤负荷,桥接异基因造血干细胞移植后再次获得完全缓解。结论伴KIT基因突变AML具有一定的异质性,部分患者治疗难度大,预后极差;复发患者选择维奈克拉联合阿伐替尼治疗达MLFS或完全缓解后,桥接(二次)造血干细胞移植可作为此类患者的较好治疗选择。

Objective To investigate the therapeutic efficacy of venetoclax combined with avapritinib in treatment of refractory/relapsed acute myeloid leukemia(AML)with KIT gene mutation.Methods The clinical data of 2 AML patients with KIT gene mutation who received venetoclax combined with avapritinib admitted to Canglang Hospital of Suzhou in October 2022 and November 2022 were retrospectively analyzed,and the relevant literature was reviewed.Results Both patients with high⁃risk relapsed/refractory AML and KIT gene mutation were females;the one was 53 years and the other was 17 years.Case 1 was diagnosed with AML⁃M2,and genetic testing revealed positive mutations in ASXL1,KIT,and RUNX1.The patient relapsed after transplantation and then was treated with venetoclax combined with avapritinib achieving morphologic leukemia⁃free status(MLFS).Case 2 was diagnosed with AML,and RUNX1⁃RUNX1T1(AML1⁃ETO)fusion gene and KIT and DX15 gene mutations were detected.The patient was treated with venetoclax combined with avapritinib regimen after relapse,and the treatment regimen significantly reduced the tumor load.Complete remission was achieved after bridging to allogeneic hematopoietic stem cell transplantation.Conclusions AML with KIT gene mutation is heterogeneous and some patients are difficult to treat with very poor prognosis.Bridging(secondary)hematopoietic stem cell transplantation can be the better treatment choice for relapsed patients achieving MLFS or complete remission after venetoclax combined with avapritinib treatment regimen.