摘要
目的探讨维奈克拉(Venetoclax,Ven)联合多药化疗治疗复发难治早期前体T淋巴细胞白血病(R/R ETP-ALL)患者的疗效及安全性。方法回顾性分析2018年12月至2022年2月在苏州大学附属第一医院住院治疗的15例R/R ETP-ALL患者的临床资料。再诱导治疗以Ven为基础联合多药化疗,其中8例联合去甲基化药物,4例同时联合去甲基化药物和HAAG方案,2例同时联合去甲基化药物和CAG预激方案,1例联合克拉屈滨。Ven用法为100 mg第1天,200 mg第2天,400 mg第3~28天,口服;联合唑类抗真菌药物时减量至100 mg/d。结果 15例R/R ETP-ALL患者中,男10例,女5例,中位年龄35(12~42)岁。难治4例,复发11例。用药第21天疗效:完全缓解(CR)率为60.0%(9/15),CR伴血液学不完全恢复(CRi)率为6.7%(1/15),总有效率(ORR)为66.7%。所有患者12个月总生存(OS)率为60.0%,中位OS时间为17.7个月;全部CR患者12个月无病生存(DFS)率为60.0%,中位DFS时间未达到。14例(93.3%)患者发生了3级及以上血液学不良反应,所有患者经治疗后造血功能恢复且无致死性大出血发生;无患者出现神经系统不良反应及肿瘤溶解综合征,同时无3级及以上脏器不良反应发生。结论 Ven联合多药化疗治疗R/R ETP-ALL疗效值得肯定,治疗相关不良反应可耐受。
Objective To explore the efficacy and safety of Venetoclax combined with multidrug chemotherapy in patients with relapsed or refractory early T-cell precursor acute lymphoblastic leukemia(R/R ETP-ALL).Methods This study retrospectively analyzed 15 patients with R/R ETP-ALL who received Venetoclax combined with multidrug chemotherapy from December 2018 to February 2022.Among them,eight cases were combined with demethylated drugs,four cases were combined with demethylated drugs and HAAG chemotherapy regimen,two cases were combined with demethylated drugs and CAG regimen,and one case was combined with Cladribine.Specific usage and dosage of Venetoclax:100 mg on day 1,200 mg on day 2,400 mg on day 3-28,orally;when combined with azole antifungal drugs,dosage was reduced to 100 mg/d.Results Fifteen patients(10 males and 5 females)with R/R ETP-ALL were treated with Venetoclax and multidrug chemotherapy with a median age of 35(12-42)years old.Of 4 refractory and 11 relapsed patients,the efficacy was evaluated on the 21th day following combined chemotherapy:the overall response rate,the complete response(CR)rate,and the CR with incomplete hematological recovery(CRi)rate were 67.7%(10/15),60.0%(9/15),and 6.7%(1/15),respectively.For the overall study population,the 12-month overall survival(OS)rate was 60.0%,and the median OS was 17.7 months.The disease-free survival(DFS)rate of all CR patients at 12 months was 60.0%,and the median DFS did not reach.About 14 patients hadⅢ-Ⅳhematological toxicity,but these adverse reactions were all controllable.No adverse reaction in the nervous system and tumor lysis syndrome occurred in this study,and no adverse reaction of organs above gradeⅢoccurred.Conclusion Venetoclax combined with multidrug chemotherapy may be a safe and promising treatment option for patients with R/R ETP-ALL.
作者
孔金玉
宗李红
浦妍
刘吟
孔欣
郦梦云
张剑
宋宝全
薛胜利
唐晓文
仇惠英
吴德沛
Kong Jinyu;Zong Lihong;Pu Yan;Liu Yin;Kong Xin;Li Mengyun;Zhang Jian;Song Baoquan;Xue Shengli;Tang Xiaowen;Qiu Huiying;Wu Depei(The First Affiliated Hospital of Soochow University,Jiangsu Institute of Hematology,National Clinical Research Center for Hematologic Diseases,Suzhou 215006,China)
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2023年第8期649-653,共5页
Chinese Journal of Hematology
基金
江苏省自然科学基金面上项目(BK20201168)。
