摘要
目的分析维奈克拉(VEN)联合阿扎胞苷(AZA)加供者淋巴细胞输注治疗髓系肿瘤异基因造血干细胞移植(allo-HSCT)后复发的临床疗效及安全性。方法回顾性分析2018年9月至2022年6月在广西医科大学第一附属医院接受allo-HSCT后复发,并接受VEN+AZA+供者淋巴细胞输注(DLI)挽救性治疗的8例急性髓系白血病(AML,5例)和骨髓增生异常综合征(MDS,3例)患者的临床资料,评价其治疗效果、并发症及生存状态。结果8例患者中男女各4例,中位年龄为31(15~64)岁。allo-HSCT后复发的中位时间为316(77~1099)d,接受VEN+AZA挽救性治疗的中位时间为10(4~25)d,中位疗程为3.5(1~6)个。5例患者接受第1次VEN+AZA+DLI治疗后达到完全缓解(CR)/血细胞计数未完全恢复的完全缓解(CRi),1例患者在第2疗程联合达雷妥尤单抗治疗后获得CR。2例患者接受首次治疗后仍为未缓解(NR)。中位随访时间为429(40~746)d。8例患者中4例存活(均为首次治疗后即获得并持续CR/CRi的患者);4例死亡,其中3例因疾病进展死亡[2例为AML,1例为治疗相关性骨髓增生异常综合征(t-MDS)],1例AML患者因肺部感染导致呼吸衰竭死亡。中位生存时间为429(40~746)d,预计2年总生存率为41.67%。结论VEN+AZA+DLI治疗allo-HSCT后复发的髓系肿瘤有效,耐受性良好。
Objective To analyze the efficacy and safety of venetoclax(VEN)combined with azacitidine(AZA)and donor lymphocyte infusion(DLI)in treatment of the relapse of myeloid malignancies after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods The clinical data of 8 patients with acute myeloid leukemia(AML,5 cases)and myelodysplastic syndrome(MDS,3 cases)who relapsed after allo-HSCT and received salvage therapy with VEN+AZA+DLI at the First Affiliated Hospital of Guangxi Medical University from September 2018 to June 2022 were retrospectively analyzed to evaluate the therapeutic efficacy,side effects and overall survival.Results Among the 8 patients,4 cases were male and the other 4 cases were female,with a median age of 31(15-64)years.The median time of relapse after allo-HSCT was 316(77-1099)days.The median time for the patients from relapse to receiving salvage therapy with VEN+AZA was 10(4-25)days,and the median course of salvage therapy was 3.5(1-6).Five patients achieved complete remission(CR)/complete remission with incomplete count recovery(CRi)after receiving the first course of VEN+AZA+DLI.One patient achieved CR after receiving the second course of combined treatment with daratuzumab.Two patients still had non-remission(NR)after receiving the first course of treatment.The median follow-up time was 429(40-746)days.Among the 8 patients,4 cases(who achieved and maintained CR/CRi after the first course of treatment)survived,and 4 cases died.Among the 4 deaths,3 cases died due to disease progression[2 cases suffered from AML and 1 case suffered from therapy-related myelodysplastic syndrome(t-MDS)],and 1 AML patient died of respiratory failure due to pulmonary infection.The median survival time was 429(40-746)days,and the overall estimated 2-year survival rate was 41.67%.Conclusion VEN+AZA+DLI is effective in treatment of the relapse of myeloid malignancies after allo-HSCT and is well tolerated by the patients.
作者
施玲玲
吴梅青
刘练金
刘倍材
赖永榕
赵卫华
刘振芳
陈英华
章忠明
SHI Ling-ling;WU Mei-qing;LIU Lian-jin(Department of Haematology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)
出处
《中国临床新医学》
2023年第11期1130-1135,共6页
CHINESE JOURNAL OF NEW CLINICAL MEDICINE
基金
广西医疗卫生适宜技术开发与推广应用项目(编号:S2018009)。
关键词
异基因造血干细胞移植
复发
髓系肿瘤
维奈克拉
阿扎胞苷
供者淋巴细胞输注
Allogeneic hematopoietic stem cell transplantation(allo-HSCT)
Relapse
Myeloid malignancies
Venetoclax
Azacitidine
Donor lymphocyte infusion
