干扰素、白细胞介素2联合来那度胺治疗微小残留病阳性老年急性髓系白血病1例并文献复习

Interferon,interleukin 2 combined with lenalidomide for elderly acute myeloid leukemia with minimal residual disease⁃positive:report of 1 case and review of literature

目的探讨干扰素、白细胞介素2(IL⁃2)联合来那度胺治疗微小残留病(MRD)阳性老年人急性髓系白血病(AML)的效果。方法回顾性分析郑州大学附属肿瘤医院2019年12月收治的1例应用干扰素、IL⁃2联合来那度胺治疗的持续MRD阳性老年AML患者的临床资料,并复习相关文献。结果患者为72岁男性,经实验室相关检查、流式细胞术、基因检测等确诊为AML⁃M2b(伴c⁃kit突变,低危组)。行标准VA(维奈克拉、阿扎胞苷)方案治疗1个周期未缓解,IA(伊达比星、阿糖胞苷)方案再诱导1个周期后达完全缓解(CR);后应用中剂量阿糖胞苷、D⁃CAG(地西他滨、阿糖胞苷、阿柔比星、粒细胞集落刺激因子)方案巩固治疗,其间AML1⁃ETO融合基因进行性升高;给予程序性死亡受体1(PD⁃1)抑制剂为基础的联合治疗,AML1⁃ETO融合基因维持阴性达1个月余,后再次升高;给予患者沙利度胺联合干扰素、IL⁃2方案治疗,AML1⁃ETO融合基因维持阴性达7个月余,后再次升高,将沙利度胺调整为来那度胺继续治疗。截至2023年5月,AML1⁃ETO融合基因再次维持阴性2年。结论干扰素、IL⁃2联合来那度胺对于逆转MRD阳性的效果显著且不良反应小,可成为治疗难治性AML的一种新选择。

Objective To investigate the effect of interferon,interleukin 2(IL⁃2)combined with lenalidomide in the treatment of acute myeloid leukemia(AML)with minimal residual disease(MRD)⁃positive.Methods The clinical data of 1 elderly AML patient with persistent MRD positive treated with interferon,IL⁃2 combined with lenalidomide in the Affiliated Cancer Hospital of Zhengzhou University in December 2019 were retrospectively analyzed,and the relevant literature was reviewed.Results The 72⁃year⁃old male patient was diagnosed as AML⁃M2b with c⁃kit mutation,the low⁃risk group according to laboratory related examinations,flow cytometry,genetic testing.The patient did not achieve remission after 1 cycle of standard VA(venetoclax+azacitidine)regimen,and achieved complete remission(CR)after another 1 cycle of IA(idarubicin+cytarabine)induction regimen,followed by consolidation therapy with medium dosage cytarabine and D⁃CAG(decitabine+cytarabine+aclarubicin+granulocyte colony⁃stimulating factor)regimen,during which the AML1⁃ETO fusion gene progressively increased.After programmed death receptor 1(PD⁃1)inhibitor⁃based combination therapy,the AML1⁃ETO fusion gene remained negative for more than 1 month,and then increased again;subsequently,the patient was treated with the ITI(interferon,thalidomide,and interleukin⁃2)regimen,and the AML1⁃ETO fusion gene remained negative for more than 7 months;thalidomide was changed to lenalidomide after the increase again,and AML1⁃ETO fusion gene remained negative again for 2 years until May 2023.Conclusions Interferon,IL⁃2 combined with lenalidomide have a significant therapeutic efficacy in reversing MRD positive and have mild adverse reactions,which can be used as a new option for refractory AML.