A Study on the Effectiveness of Decitabine Combined with a Half-Dose Priming Regimen in the Treatment of Elderly Patients with Acute Myeloid Leukemia

Objective:To investigate the clinical effects of combining decitabine with a half-dose priming regimen in the treatment of elderly patients with acute myeloid leukemia.Methods:This study was conducted in Shaanxi Provincial People's Hospital from January 2019 to January 2022.Sxty patients were recruited as the research subects.The patients received different treatments and were randomly divided into two groups,with 30 cases in each group,one of which was treated with conventional priming regimen(control group),and the other was treated with decitabine combined with a half-dose priming regimen(study group).The two groups were compared and analyzed in terms of the effectiveness of treatment.Results:The rate of symptom relief in the study group was 96.67%,which was significantly higher than that in the control group(76.67%)(p<0.05).Before treatment,there was no significant difference in the quality-of-life scores between the two groups,with p>0.05.The patients in the study group had sigificantly longer discase free survival and overall survival than those in the control group,with p<0.05.The effectiveness of treatment in the study group was also better.Conclusion:The use of decitabine im combination with a half dose priming regimen for the treatment of elderly patients with acute myeloid lcukemia is effective in improving patients'quality of life,relieving symptoms.and prolonging their survival.

Clinical Efficacy of Decitabine/Azacitidine in Combination with HAG in the Treatment of Elderly Patients with Acute Myeloid Leukemia

This study was conducted to investigate the clinical effect of combining decitabine/azacitidine with HAG in the treatment of single elderly patients with acute myeloid leukemia.Patients in Shaanxi Provincial People’s Hospital were selected for this study from January 2020 to January 2022,and all of the patients were elderly patients with acute myeloid leukemia.Around 23 patients were selected for this study,subsequently the patients were divided into two groups;Group A contained 11 patients and was given decitabine in combination with HAG;and Group B contained 12 patients,and was given azacitidine in combination with HAG.This study showed that the treatment effective rates of patients in both groups were 90.91%and 58.33%,respectively,with a small difference(p>0.05)in the data comparison.The incidence of adverse reactions in the two groups was 63.64%and 16.67%,respectively,with the incidence in group B is significantly(p<0.05)lower compared with group A.Meanwhile,compared with group B,patients in group A had a significantly(p<0.05)shorter mean time to WBC normalization,higher HB and PLT levels,lower WBC levels were lower,all the survival duration times were longer,and subpopulation indicators of peripheral blood T lymphocytes were more in line with normal values.In summary,this study demonstrated that the combination of azacitidine and HAG therapies for the treatment of elderly patients with acute myeloid leukemia is more effective,furthermore can reduce significantly the incidence of adverse treatment effects in patients.

Clinical Effects of Venetoclax in the Treatment of Acute Myeloid Leukemia in the Elderly

Objective: To investigate the clinical efficacy of venetoclax in the treatment of elderly acute myeloid leukemia (AML). Methods: 50 cases of elderly AML patients receiving venetoclax for treatment in the hospital from January 2022 to January 2024 were selected, including 38 cases of patients whose primary treatment was not suitable for intensive chemotherapy and 12 cases of relapsed/refractory AML patients, to observe the therapeutic efficacy and safety of venetoclax. Results: Among the 38 patients whose primary treatment was not suitable for intensive chemotherapy, 5 cases were treated with venetoclax monotherapy, 33 cases were treated with venetoclax + azacitidine, and 25 patients (65.79%) achieved complete remission (CR) with incomplete hematologic recovery (CRi) after 28 days of treatment;10 patients with relapsed/refractory AML were treated with venetoclax + azacitidine, and 2 patients were treated with venetoclax + azacitidine + chemotherapy, and 2 patients achieved optimal therapeutic response after 28 days of treatment and CR/CRi was achieved in 7 patients (58.33%). There were 47 (94.0%) patients with grade 3 or higher granulocytopenia, 46 (92.0%) patients with hemoglobin reduction, and 43 (86.0%) patients with thrombocytopenia, developed after 28 days of treatment. 11 patients developed infections after treatment and there was one case of tumor lysis syndrome. Conclusion: The response rate of venetoclax monotherapy and combination in elderly AML induction therapy is high, and the overall tolerability of elderly patients is good, so it can be popularized and applied.

Easily manageable prognostic factors in 152 Chinese elderly acute myeloid leukemia patients:a single-center retrospective study

We retrospectively investigated the prognostic factors of acute myeloid leukemia（AML） in 152 Chinese patients with de novo AML who were older than 60 years of age and who received treatment at our hospital.Log-rank test showed that 6 parameters including older age,higher white blood cell（WBC） counts,lactate dehydrogenase（LDH）and bone marrow（BM） blasts at diagnosis,unfavorable risk cytogenetics,and non-mutated CEBPα were significant adverse prognostic factors of overall survival（OS） for elderly AML patients（P = 0.0013,0.0358,0.0132,0.0242,0.0236 and 0.0130,respectively）.Moreover,older age and higher LDH were significant adverse predictors for relapse-free survival（RFS）（P = 0.0447 and 0.0470,respectively）.Univariate analysis revealed similar results for OS to those of the log-rank test and only higher LDH at diagnosis was a significant adverse predictor for RFS（P = 0.028,HR：1.979,95%CI：1.075-3.644）.In multivariate analysis,we identified 2 trends towards independent prognostic factors for OS,including BM blasts at diagnosis（P = 0.057,HR：1.676,95%CI：0.984-2.854）and mutation status of CEBPα（P = 0.064,HR：4.173,95%CI：0.918-18.966）.Our data indicated that older age,gender and a previous history of hematologic diseases resulted in lower complete remission rate（P = 0.012,0.051 and 0.086,respectively）.We further developed an easy scoring system for predicting prognosis and response to induction therapy in older AML patients.Patients who had lower scores showed significantly longer OS and RFS（P = 0.0006 and 0.1001,respectively） and higher CR rate（P = 0.014）.Our research is limited by its retrospective nature and the results from our study need to be further validated by prospective randomized clinical trials.

A phase Ⅳ study of homoharringtonine, cytarabine, aclacinomycin and G-CSF(HCAG) regimen compared with traditional IA regimen in the treatment of newly diagnosed elderly acute myeloid leukemia patients

Objective · To compare the efficacy and prognostic factors of HCAG regimen with traditional IA regimen in the treatment of newly diagnosed elderly acute myeloid leukemia(AML) patients. Methods · Forty-one patients with AML(aged 55-71 years) were randomly divided into two groups(Group HCAG and Group IA) between 2014 and 2016 for induction and consolidation therapy. Multivariate analysis was applied to identify prognostic factors for relapse-free survival(RFS). Results · A total of 29 patients(70.7%) achieved complete remission(CR). The estimated 2-year overall survival(OS) was 66.8% in Group HCAG and 75.4% in Group IA(P=0.913). The estimated 2-year RFS was 61.8% in Group HCAG and 49.1% in Group IA(P=0.411). Age remained as the unfavorable prognostic factor, leading to significant differences in OS and RFS. In addition, RFS was influenced by cytogenetic/molecular risk stratification. Conclusion · Although HCAG seemed not to particularly benefit the group, the dose reduction of anthracyclines may be applied in elderly patients with comparable short-time outcome. Furthermore, the introduction of homoharringtonine resulted in an improvement of treatment response for more than 20% compared with CAG regimen.

Treatment patterns and a prognostic scoring system for elderly acute myeloid leukemia patients:a retrospective multicenter cohort study in China

Objective:Acute myeloid leukemia(AML)is primarily a malignant disorder affecting the elderly.We aimed to compare the outcomes of different treatment patterns in elderly AML patients and to propose a prognostic scoring system that could predict survival and aid therapeutic decisions.Methods:Patients aged≥60 years who had been diagnosed with AML at 7 hospitals in China were enrolled(n=228).Treatment patterns included standard chemotherapy,low intensity therapy,and best supportive care(BSC).Results:The early mortality rates were 31%,6.8%,and 6.3%for the BSC,low intensity therapy,and standard chemotherapy groups,respectively.The complete remission rate of the standard chemotherapy group was higher than that of the low intensity therapy group.The median overall survival(OS)was 561 days and 222 days for the standard chemotherapy and low intensity therapy groups,respectively,and were both longer than that of the BSC group(86 days).Based on multivariate analyses,we defined a prognostic scoring system that enabled classification of patients into 3 risk groups,in an attempt to predict the OS of patients receiving chemotherapies and low intensity therapies.Low and intermediate risk patients benefited more from standard chemotherapies than from low intensity therapies.However,the median OS was comparable between standard chemotherapies and low intensity therapies in high risk patients.Conclusions:Our prognostic scoring system could predict survival and help select appropriate therapies for elderly AML patients.Standard chemotherapy is important for elderly AML patients,particularly for those categorized into low and intermediate risk groups.

Comparing Arsenic-Containing Qinghuang Powder and Low-Intensity Chemotherapy in Elderly Patients with Acute Myeloid Leukemia

Objective To compare the clinical effect of arsenic-containing Qinghuang Powder(QHP)and low-intensity chemotherapy(LIC)in treatment of elderly acute myeloid leukemia(eAML)patients.Methods Clinical data of 80 eAML patients treated at Xiyuan Hospital of China Academy of Chinese Medical Sciences from January 2015 to December 2020 were retrospectively analyzed.The treatment scheme was designed by real world study according to patients’preference,and patients were divided into a QHP group(35 cases)and a LIC group(45 cases).The median overall survival(mOS),1-,2-,and 3-year OS rates,and incidence of adverse events were compared between the two groups.Results The mOS of 80 patients was 11 months,and the 1-,2-,and 3-year OS rates were 45.51%,17.96%,and 11.05%,respectively.The QHP and LIC groups demonstrated no significant difference in mOS(12 months vs.10 months),1-(48.57%vs.39.65%),2-(11.43%vs.20.04%),and 3-year OS rates(5.71%vs.13.27%,all P>0.05).Moreover,the related factors of mOS demonstrated no significant difference in patients with age>75 years(11 months vs.8 months),secondary AML(11 months vs.8 months),poor genetic prognosis(9 months vs.7 months),Eastern Cooperative Oncology Group performance status score≥(10 months vs.7 months)and hematopoietic stem cell transplant comorbidity index≥4(11 months vs.7 months)between the QHP and LIC groups(all P>0.05).However,the incidence of myelosuppression was significantly lower in the QHP group than that in the LIC group(28.57%vs.73.33%,P<0.01).Conclusions QHP and LIC had similar survival rates in eAML patients,but QHP had a lower myelosuppression incidence.Hence,QHP can be an alternative for eAML patients who do not tolerate LIC.

Gene mutations in a patient with chronic myelomonocytic leukemia and changes upon progression to acute myeloid leukemia and during treatment

Objective Chronic myelomonocytic leukemia(CMML) has been categorized as an uncommon hematological malignancy with overlapping features of myelodysplastic syndromes(MDS) and myeloproliferative neoplasms that have an inherent risk of progressing to acute myeloid leukemia(AML). Methods This study presents a case of confirmed CMML combined with M protein, in which the molecular changes upon progression to AML and under decitabine(DAC) plus bortezomib therapy were reported by tracking variant allele frequency(VAF) of mutations in a series of bone marrow samples. Results First, variable sensitivity of clones was observed during DAC treatment, and incomplete mutation clearance may be associated with low overall response rate and unsustained response. Secondly, DAC cannot prevent the new genetic alterations and accumulation of genetic progression on treatment, leading to acute transformation. Finally, autoimmunity was found to have acted as an important pathogenetic factor, increasing the additive mutations that further drive the clonal evolution in CMML. Conclusion Overall, changes in mutations and clonal architecture during CMML progression or treatment are predictive of an early evaluation of therapeutic strategies in CMML.

Age is an independent adverse prognostic factor for overall survival in acute myeloid leukemia in Japan

AIM: To elucidate risk factors for survival of elderly acute myeloid leukemia(AML) patients in a real-world practice by observational study. METHODS: We conducted a population-based study in 213 adult and elderly AML patients(127 males and 86 females) in Kagawa Prefecture, Japan. To construct this cohort, we gathered all data for patients diagnosed with AML at 7 hospitals in Kagawa between 2006 and 2010. The primary end point was overall survival(OS) after AML diagnosis. Unadjusted Kaplan-Meier survival plots were used to determine OS in the overall cohort. Multivariate analysis was used to determine the independent adverse prognostic factors for OS, with the covariates of interest including age, gender, race/ethnicity, CCI, education, median income, metropolitan statistical area size and history of myelodysplastic syndrome.RESULTS: The average population of Kagawa during the study period was 992489, and the incidence of AML was 4.26 per 100000 person-years. A total of 197 patients with non-acute promyelocytic leukemia(non-APL)(119 males and 78 females) were also included. The median age of non-APL patients was 70 years(average 67, range 24-95). The 5-year OS rate was 21.1%. Subsequent analysis by age group showed that the survival rate declined with age; the 5-year OS rates of non-APL patients younger than 64 years, 65-74 years, and older than 75 years were 41.5%, 14.1%, and 8.9%, respectively. Multivariate analysis revealed that unfavorable risk karyotype, older age, poor performance status(PS)(3-4), lack of induction chemotherapy, and antecedent haematological disease were independent prognostic predictors. In the subgroup analysis, we also found that older patients with non-APL had lower complete remission rates and higher early death rates than younger patients, irrespective of PS. However, intensive chemotherapy was a significant predictor for longer survival not only in the patients < 75 years of age, but also in those over 75 with PS 0-2. CONCLUSION: Age would contribute considerable life expectancy to indicate induction chemotherapy with eligible dose of cytotoxic drugs for a favorable case even in advanced elderly.

Arsenic-Containing Qinghuang Powder(青黄散)Is An Alternative Treatment for Elderly Acute Myeloid Leukemia Patients Refusing Low-Intensity Chemotherapy

Objective:To analyze the overall survival(OS)of elderly acute myeloid leukemia(AML)patients treated with oral arsenic-containing Qinghuang Powder(青黄散,QHP)or low-intensity chemotherapy(LIC).Methods:Forty-two elderly AML patients treated with intravenous or subcutaneous LIC(1 month for each course,at least 3 courses)or oral QHP(3 months for each course,at least 2 courses)were retrospectively analyzed from January 2015 to December 2017.The main endpoints of analysis were OS and 1-,2-,3-year OS rates of patients,respectively.And the adverse reactions induding bone marrow suppression,digestive tract discomfort and myocardia injury were observed.Results:Out of 42 elderly AML patients,22 received LIC treatment and 20 received QHP treatment,according to patients'preference.There was no significant difference on OS between LIC and QHP patients(13.0 months vs.13.5 months,P>0.05).There was no significant difference on OS rates between LIC and QHP groups at 1 year(59.1%vs.70.0%),2 years(13.6%vs.15%),and 3 years(4.6%vs.5.0%,all P>0.05).Furthermore,there was no significant difference of OS on prognosis stratification of performance status>2(12 months vs.12 months),age>75 year-old(12.0 months vs.12.5 months),hematopoietic stem cell transplant comorbidity index>2(12 months vs.13 months),poor cytogenetics(12 months vs.8 months),and diagnosis of secondary AML(10 months vs.14 months)between LIC and QHP patients(P>0.05).Conclusion:QHP may be an alternative treatment for elderly AML patients refusing LIC therapy.

EVI1 expression,clinical and cytogenetical characteristics in 447 patients with acute myeloid leukemia

Objective To investigate EVI1 expression and its associated clinical and cytogenetic characteristics in 447acute myeloid leukemia(AML)patients.Methods EVI1expressions were measured in 447 AML cases from Jan.2007 to Apr.2015 to couple with clinical。

Efficacy and safety analysis of the combination of cladribine,cytarabine,granulocyte colony stimulating factor( CLAG ) regime in patients with refractory or relapsed acute myeloid leukemia

Objective To analyze efficacy and safety of CLAG regimen in patients with refractory or relapsed acute myeloid leukemia(AML).Methods Efficacy and adverse events of patients with refractory or relapsed AML who were treated with one course of CLAG from April 1st,2014 through December 9th,2015 in our hospital were retrospectively reviewed.Results Thirty-three

Resistance to venetoclax and hypomethylating agents in acute myeloid leukemia

Despite the success of the combination of venetoclax with the hypomethylating agents(HMA)decitabine or azacitidine in inducing remission in older,previously untreated patients with acute myeloid leukemia(AML),resistance-primary or secondary-still constitutes a significant roadblock in the quest to prolong the duration of response.Here we review the proposed and proven mechanisms of resistance to venetoclax monotherapy,HMA monotherapy,and the doublet of venetoclax and HMA for the treatment of AML.We approach the mechanisms of resistance to HMAs and venetoclax in the light of the agents’mechanisms of action.We briefly describe potential therapeutic strategies to circumvent resistance to this promising combination,including alternative scheduling or the addition of other agents to the HMA and venetoclax backbone.Understanding the mechanisms of action and evolving resistance in AML remains a priority in order to maximize the benefit from novel drugs and combinations,identify new therapeutic targets,define potential prognostic markers,and avoid treatment failure.

Epigenetic therapies in acute myeloid leukemia: the role of hypomethylating agents, histone deacetylase inhibitors and the combination of hypomethylating agents with histone deacetylase inhibitors

Epigenetic regulation includes changes of DNA methylation and modifications of histone proteins and is essential for normal physiologic functions,especially for controlling gene expression.Epigenetic dysregulation plays a key role in disease pathogenesis and progression of some malignancies,including acute myeloid leukemia(AML).Epigenetic therapies,including hypomethylating agents(HMAs)and histone deacetylase(HDAC)inhibitors,were developed to reprogram the epigenetic abnormalities in AML.However,the molecular mechanisms and therapeutic effects of the two agents alone or their combination remain unknown.An overview of these epigenetic therapies is given here.A literature search was conducted through PubMed database,looking for important biological or clinical studies related to the epigenetic regimens in the treatment of AML until October 15th,2019.Various types of articles,including original research and reviews,were assessed,identified,and eventually summarized as a collection of data pertaining the mechanisms and clinical effects of HMAs and HDAC inhibitors in AML patients.We provided here an overview of the current understanding of the mechanisms and clinical therapeutic effects involved in the treatment with HMAs and HDAC inhibitors alone,the combination of epigenetic therapies with intensive chemotherapy,and the combination of both types of epigenetic therapies.Relevant clinical trials were also discussed.Generally speaking,the large number of studies and their varied outcomes demonstrate that effects of epigenetic therapies are heterogeneous,and that HMAs combination regimens probably contribute to significant response rates.However,more research is needed to explore therapeutic effects of HDAC inhibitors and various combinations of HMAs and HDAC inhibitors.

超低剂量地西他滨联合GHA预激治疗复发难治性急性髓系白血病疗效研究

目的探讨超低剂量地西他滨联合高三尖杉酯碱(HHT)、阿糖胞苷(Ara-c)和粒细胞集落刺激因子(G-CSF)的GHA预激方案治疗复发难治性急性髓系白血病(AML)的临床疗效及其安全性。方法回顾性分析2018年1月—2023年8月在我院接受2个疗程超低剂量地西他滨联合GHA预激方案(具体为:地西他滨10 mg/d,静脉滴注,第1~5天;HHT 1 mg/d,静脉滴注,第1~14天;Ara-c 10 mg,q 12 h,皮下注射,第1~14天;G-CSF 300μg,皮下注射,第0~14天)治疗的28例复发难治性AML患者的临床资料,评价治疗效果及不良反应。结果2疗程后共有17例患者获得完全缓解(CR)(60.7%),6例获得部分缓解(PR)(21.4%),总有效率(ORR)82.1%。26例(92.9%)患者发生IV级骨髓抑制,中性粒细胞缺乏的比例为85.7%(24例),平均持续时间7 d(3~14 d);血小板<20×10^(9)/L的比例为89.3%(25例),平均持续时间8 d(5~17 d)。非血液系统不良反应轻微,无早期死亡发生。结论超低剂量地西他滨联合GHA预激方案治疗复发难治性AML缓解率高,耐受性好,可在临床推广应用。

地西他滨联合预激方案治疗首程标准诱导化疗未缓解初诊AML患者的效果观察

目的:探讨地西他滨联合预激方案治疗首程标准诱导化疗未缓解初诊急性髓系白血病(AML)患者的疗效及对调节性T淋巴细胞(Treg)相对含量的影响。方法:收集2013年3月-2019年3月陕西省人民医院收治的102例初诊经首程标准诱导化疗未缓解的AML患者(除急性早幼粒细胞白血病)的临床资料进行回顾性分析,根据治疗方案不同对患者进行分组,51例采用预激方案治疗为常规组,51例采用地西他滨联合预激方案治疗为联合组。比较两组疗效、毒副反应发生率、治疗前后生活质量核心量表(QLQ-C30)评分、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、Treg)及3年总生存率。结果:联合组治疗总有效率为80.39%,显著高于常规组的62.75%(P<0.05);治疗后联合组QLQ-C30评分为60.27±6.96,较常规组65.73±7.96低(P<0.001);两组毒副反应发生率比较,差异无统计学意义(P>0.05);治疗后联合组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平较常规组高(均P<0.001),而Treg水平较常规组低(P<0.001);联合组3年总生存率为72.55%,高于常规组的52.94%(P<0.001)。结论:地西他滨联合预激方案治疗初诊首程标准诱导化疗未缓解AML患者效果显著,可通过调节Treg相对含量减少抗肿瘤免疫抑制,增强机体免疫功能,从而延长患者生存时间,提高生存质量,且未增加不良反应。

维奈克拉联合阿扎胞苷治疗不耐受强化疗的初治老年急性髓系白血病的临床疗效

目的:总结35例不耐受强化疗的初治老年急性髓系白血病(acute myeloid leukemia,AML)的临床特点,评估维奈克拉(venetoclax,VEN)联合阿扎胞苷(azacytidine,AZA)的疗效及安全性。方法:纳入本院2021年2月至2022年3月间诊断的35例不耐受强化疗的初治老年AML患者,接受VEN+AZA诱导治疗,回顾性分析其临床特征、VEN+AZA诱导的缓解情况及治疗安全性。结果:患者中位年龄68岁,继发AML 9例。所有患者均完成骨髓细胞遗传学及分子生物学评估,其中低危患者10例,中危12例,高危13例。常见的基因突变为DNA甲基转移酶3A(DNA methyltransferase 3A,DNMT3A)(11例)、异柠檬酸脱氢酶1/2(isocitrate dehydrogenase 1/2,IDH1/2)(11例)、TET癌基因家族成员2(ten⁃eleven translocation 2,TET2)(9例)、核仁磷酸蛋白1(nucleophosmin 1,NPM1)(8例)、Fms⁃样酪氨酸激酶3⁃内部串联重复(Fms⁃related tyrosine kinase 3⁃internal tandem duplication,FLT3⁃ITD)(6例)。总完全缓解(complete remission,CR)率65.7%(23例),NPM1、FLT3⁃ITD、IDH1/2突变患者CR率分别为87.5%、66.7%、72.7%。CR患者中总微小残留病变(minimal residual disease,MRD)阴性率73.9%。中位随访时间10.1个月,中位无事件生存(event⁃free survival,EFS)期11.3个月。缓解患者中,相比于MRD阳性患者,MRD阴性患者EFS及总生存(overall survival,OS)期更长(P<0.05)。早期死亡率5.7%,治疗过程中最常见的不良反应为血液学毒性(3~4级中性粒细胞减少31.4%、3~4级血小板减少25.7%、中性粒细胞减少性发热48.6%)及肺部感染(17.1%)。结论:VEN+AZA在不耐受强化疗的初治老年AML中治疗的总缓解率较高。NPM1突变可能提示更高缓解率。MRD转阴患者EFS期及OS期较MRD阳性患者延长,死亡风险下降。VEN+AZA是目前不能耐受强化疗的初治老年AML重要的治疗选择之一。

半量CAG方案联合地西他滨治疗老年初诊急性髓系白血病患者的效果

目的:观察半量CAG方案联合地西他滨治疗老年初诊急性髓系白血病患者的效果。方法:选取2020年1月至2023年1月于该院就诊的108例老年初诊急性髓系白血病患者进行前瞻性研究,按随机数字表法将其分为对照组和观察组各54例。对照组予以地西他滨治疗,观察组在对照组基础上联合半量CAG方案治疗,比较两组临床缓解率、住院时间、治疗前后T细胞亚群指标水平和治疗期间不良反应发生率。结果:观察组临床缓解率为72.22%(39/54),高于对照组的40.74%(22/54),差异有统计学意义(P<0.05);观察组住院时间短于对照组,差异有统计学意义(P<0.05);治疗后,两组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:半量CAG方案联合地西他滨治疗老年初诊急性髓系白血病患者可提高临床缓解率,缩短住院时间,降低T细胞亚群指标水平,效果优于单纯地西他滨治疗。

沙利度胺联合CAG方案治疗老年急性髓系白血病患者有效性与安全性的Meta分析

目的系统评价沙利度胺联合阿克拉霉素、粒细胞集落刺激因子与阿糖胞苷(CAG)方案治疗老年急性髓系白血病(AML)患者的疗效与安全性。方法检索中国知网、万方数据、维普网、Sino Med、PubMed、Embase、the Cochrane Library、Web of Science,检索时限为数据库建库至2023年8月27日。收集沙利度胺联合CAG方案(试验组)对比CAG方案(对照组)治疗老年AML患者的临床随机对照试验,对纳入的研究采用RevMan 5.3软件进行Meta分析。结果最终纳入7项临床随机对照试验,共计601例患者,其中试验组307例、对照组294例。Meta分析结果显示,试验组在提升总有效率[Z=4.75,P<0.00001,OR=2.80,95%CI(1.83,4.28)]、完全缓解率[Z=2.82,P=0.005,OR=1.61,95%CI(1.16,2.25)],改善血小板计数[Z=2.70,P=0.007,MD=64.02,95%CI(17.53,110.51)]、血管内皮生长因子水平[Z=13.63,P<0.00001,MD=-65.17,95%CI(-74.54,-55.80)]、血管内皮生长因子受体水平[Z=12.03,P<0.00001,MD=-499.01,95%CI(-580.31,-417.71)]、碱性成纤维细胞生长因子水平[Z=4.17,P<0.0001,MD=-0.23,95%CI(-0.35,-0.12)]等方面均显著优于对照组,不良反应发生率[Z=0.99,P=0.32,OR=0.52,95%CI(0.14,1.89)]以及恶心呕吐[Z=1.06,P=0.29,OR=0.66,95%CI(0.30,1.43)]、便秘或腹泻[Z=0.92,P=0.36,OR=0.65,95%CI(0.26,1.63)]、嗜睡[Z=1.38,P=0.17,OR=0.57,95%CI(0.26,1.27)]、骨髓抑制[Z=0.88,P=0.38,OR=0.68,95%CI(0.28,1.62)]的发生率与对照组比较,差异均无统计学意义。结论沙利度胺联合CAG方案治疗老年AML患者能显著增加疗效,且安全性较好。

低剂量阿扎胞苷联合减量HAG方案治疗老年低增生急性髓系白血病的疗效观察

目的:评价低剂量阿扎胞苷联合减量HAG方案(HHT、Ara-C、G-CSF)诱导治疗新诊断老年低增生急性髓系白血病患者的疗效及安全性。方法:将我院2019年01月至2023年01月收治的56例初诊的老年低增生急性髓系白血病患者的治疗进行回顾性分析,采用低剂量阿扎胞苷联合减量HAG方案诱导化疗,观察治疗效果并评价其安全性。结果:56例患者均完成2个疗程化疗,外周血象恢复后复查骨髓形态评估其疗效。其中达到完全缓解(complete remission,CR)的患者25例(44.6%),部分缓解(partial remission,PR)的患者11例(19.6%),未缓解(no remission,NR)的患者20例(35.7%),总有效率(overall remission rate,ORR)为64.3%(36/56)。56例患者均出现Ⅲ-Ⅳ级血液学毒性,中性粒细胞减少导致的感染及血小板减少引起的出血为主要并发症。恶心、呕吐、食纳减退、肝肾功能损害、心脏毒性等非血液学毒性均可耐受,未发生治疗相关死亡病例。性别、年龄、KPS评分对完全缓解率无明显影响(P>0.05)。不良细胞遗传学患者较正常细胞遗传学患者缓解率低,具有统计学差异(P<0.05)。结论:低剂量阿扎胞苷联合减剂量HAG方案治疗新诊断老年低增生急性髓系白血病患者疗效确切,缓解率较高,毒副作用可安全耐受。