目的:探讨基于维奈克拉(VEN)的诱导治疗在初治不宜强化化疗及复发难治(R/R)急性髓系白血病(AML)患者中的疗效及安全性。方法:回顾性分析西京医院血液内科于2021年2月1日至2022年4月30日收治的使用含维奈克拉诱导治疗的初治不适合强化化...目的:探讨基于维奈克拉(VEN)的诱导治疗在初治不宜强化化疗及复发难治(R/R)急性髓系白血病(AML)患者中的疗效及安全性。方法:回顾性分析西京医院血液内科于2021年2月1日至2022年4月30日收治的使用含维奈克拉诱导治疗的初治不适合强化化疗(初治虚弱组)及复发/难治性(R/R组)AML患者共51例的临床资料,分析患者的诱导治疗缓解率(CR/CRi)、总体反应率(ORR)、微小残留病(MRD)、治疗相关不良事件、总生存期(OS)及无进展生存期(PFS)。结果:初治虚弱组患者32例,中位年龄60(29-88)岁;R/R组患者19例,中位年龄49(22-92)岁。初治虚弱组和R/R组接受VEN治疗的中位疗程数均为2个。初治虚弱组及R/R组经1个疗程诱导治疗后CR/CRi率分别为65.6%和36.9%,ORR分别为81.3%和42.1%,经1-3个疗程治疗后累计CR/CRi率分别为71.9%和47.4%,达到CR/CRi患者的MRD转阴率分别为69.6%和33.3%。初治虚弱组及R/R组患者的中位PFS分别为8(5-11)和3(1-5)个月,中位OS分别为13(6-20)和5(3-7)个月。两组达到CR/CRi的患者中位OS均显著优于未达到CR/CRi的患者(13 vs 4个月、OS未达到vs 4个月)。首次诱导治疗期间有3级以上粒细胞、血红蛋白及血小板减少的患者分别占96%、90.2%、84.3%,粒细胞缺乏伴发热患者有30例(58.8%)。最常见的非血液学AE为感染(12/51,23.5%),其次为胃肠道反应(6/51,11.8%)。结论:以VEN为基础的治疗方案在初治不宜强化化疗及R/R AML患者中诱导治疗反应率高,总体耐受性良好,最常见的不良反应为血液学毒性及感染。展开更多
Background:The role of pre-hematopoietic stem cell transplantation(HSCT)cytoreduction with either induction chemotherapy(IC)or hypomethylating agents(HMAs)in treating advanced myelodysplastic syndrome(MDS)remains deba...Background:The role of pre-hematopoietic stem cell transplantation(HSCT)cytoreduction with either induction chemotherapy(IC)or hypomethylating agents(HMAs)in treating advanced myelodysplastic syndrome(MDS)remains debatable.We aimed to evaluate pre-HSCT strategies by comparing the endpoints related to disease control between advanced MDS patients with pre-HSCT cytoreduction and those with best supportive care.Methods:We described 228 consecutive advanced MDS patients who received HSCT from a haploidentical donor(HID,n=162)or matched related donor(MSD,n=66)with uniform myeloablative conditioning regimens between January 2015 and December 2018.Of these 228 patients,131(57.5%)were treated exclusively with pre-HSCT best supportive care(BSC),49(22.5%)were given HMA,and 48(21.1%)received both IC and HMA.Propensity score-matching analysis,multivariate analyses,and subgroup analyses were performed to elucidate the impact of pre-HSCT strategies on transplant outcomes.Results:The 3-year relapse-free survival(RFS)rates were 78.2% and 70.0% for the BSC and cytoreduction cohorts(P=0.189)and were 78.2%,66.7%,and 73.2% for the BSC,HMA,and HMA+IC groups,respectively(P=0.269).A propensity score-matching analysis confirmed that the 3-year RFS rates were 81.9%,87.5%,and 66.9% for BSC,cytoreduction complete remission(CR),and cytoreduction non-CRgroups,respectively(P=0.051).Multivariate analyses demonstrated that pre-HSCT cytoreduction,older patient age,monosomal karyotype,and interval between diagnosis and HSCT were poor prognostic factors for RFS.In the subgroup analyses,BSC was associated with longer RFS compared to cytoreduction among the younger patients,those with international prognostic scoring system intermediate-2/high risk at diagnosis,and those with intermediate/poor cytogenetics.Conclusions:Different pre-HSCT therapies did not yield discrepant post-HSCT outcomes.No benefit in terms of post-HSCT outcomes were correlated with pre-HSCT cytoreduction in advanced MDS even for cytoreduction CR patients.Early referral to HSCT is展开更多
BACKGROUND Academic studies have proved that anti-programmed death-1(PD-1)monoclonal antibodies demonstrated remarkable activity in relapsed/refractory classical Hodgkin lymphoma(cHL).However,most patients ultimately ...BACKGROUND Academic studies have proved that anti-programmed death-1(PD-1)monoclonal antibodies demonstrated remarkable activity in relapsed/refractory classical Hodgkin lymphoma(cHL).However,most patients ultimately experienced failure or resistance.It is urgent and necessary to develop a novel strategy for relapsed/refractory cHL.The aim of this case report is to evaluate the combination approach of low-dose decitabine plus a PD-1 inhibitor in relapsed/refractory cHL patients with prior PD-1 inhibitor exposure.CASE SUMMARY The patient was a 27-year-old man who complained of enlarged right-sided cervical lymph nodes and progressive pain aggravation of the right shoulder over the past 3 mo before admission.Histological analysis of lymph node biopsy was suggestive of cHL.The patient experienced failure of eight lines of therapy,including multiple cycles of chemotherapy,PD-1 blockade,and anti-CD47 antibody therapy.Contrast-enhanced CT showed that the tumors of the chest and abdomen significantly shrunk or disappeared after three cycles of treatment with decitabine plus tislelizumab.The patient had been followed for 11.5 mo until March 2,2021,and no progressive enlargement of the tumor was observed.CONCLUSION The strategy of combining low-dose decitabine with tislelizumab could reverse the resistance to PD-1 inhibitors in patients with heavily pretreated relapsed/refractory cHL.The therapeutic effect of this strategy needs to be further assessed.展开更多
文摘目的:探讨基于维奈克拉(VEN)的诱导治疗在初治不宜强化化疗及复发难治(R/R)急性髓系白血病(AML)患者中的疗效及安全性。方法:回顾性分析西京医院血液内科于2021年2月1日至2022年4月30日收治的使用含维奈克拉诱导治疗的初治不适合强化化疗(初治虚弱组)及复发/难治性(R/R组)AML患者共51例的临床资料,分析患者的诱导治疗缓解率(CR/CRi)、总体反应率(ORR)、微小残留病(MRD)、治疗相关不良事件、总生存期(OS)及无进展生存期(PFS)。结果:初治虚弱组患者32例,中位年龄60(29-88)岁;R/R组患者19例,中位年龄49(22-92)岁。初治虚弱组和R/R组接受VEN治疗的中位疗程数均为2个。初治虚弱组及R/R组经1个疗程诱导治疗后CR/CRi率分别为65.6%和36.9%,ORR分别为81.3%和42.1%,经1-3个疗程治疗后累计CR/CRi率分别为71.9%和47.4%,达到CR/CRi患者的MRD转阴率分别为69.6%和33.3%。初治虚弱组及R/R组患者的中位PFS分别为8(5-11)和3(1-5)个月,中位OS分别为13(6-20)和5(3-7)个月。两组达到CR/CRi的患者中位OS均显著优于未达到CR/CRi的患者(13 vs 4个月、OS未达到vs 4个月)。首次诱导治疗期间有3级以上粒细胞、血红蛋白及血小板减少的患者分别占96%、90.2%、84.3%,粒细胞缺乏伴发热患者有30例(58.8%)。最常见的非血液学AE为感染(12/51,23.5%),其次为胃肠道反应(6/51,11.8%)。结论:以VEN为基础的治疗方案在初治不宜强化化疗及R/R AML患者中诱导治疗反应率高,总体耐受性良好,最常见的不良反应为血液学毒性及感染。
基金partly supported by grants from the National Key Research and Development Program of China(2019YFC0840606)from the Ministry of Science and TechnologyNational Natural Science Foundation of China(Grant No.82070189&81770189&81621001&81530046)+4 种基金Peking University Clinical Scientist Program(BMU2019LCKXJ003)the Fundamental Research Funds for the Central Universitiesthe Science and Technology Project of Guangdong Province of China(Grant No.2016B030230003)the project of health collaborative innovation of Guangzhou city(no.201704020214)Beijing Municipal Science&Technology Commission(No.Z191100006619054).
文摘Background:The role of pre-hematopoietic stem cell transplantation(HSCT)cytoreduction with either induction chemotherapy(IC)or hypomethylating agents(HMAs)in treating advanced myelodysplastic syndrome(MDS)remains debatable.We aimed to evaluate pre-HSCT strategies by comparing the endpoints related to disease control between advanced MDS patients with pre-HSCT cytoreduction and those with best supportive care.Methods:We described 228 consecutive advanced MDS patients who received HSCT from a haploidentical donor(HID,n=162)or matched related donor(MSD,n=66)with uniform myeloablative conditioning regimens between January 2015 and December 2018.Of these 228 patients,131(57.5%)were treated exclusively with pre-HSCT best supportive care(BSC),49(22.5%)were given HMA,and 48(21.1%)received both IC and HMA.Propensity score-matching analysis,multivariate analyses,and subgroup analyses were performed to elucidate the impact of pre-HSCT strategies on transplant outcomes.Results:The 3-year relapse-free survival(RFS)rates were 78.2% and 70.0% for the BSC and cytoreduction cohorts(P=0.189)and were 78.2%,66.7%,and 73.2% for the BSC,HMA,and HMA+IC groups,respectively(P=0.269).A propensity score-matching analysis confirmed that the 3-year RFS rates were 81.9%,87.5%,and 66.9% for BSC,cytoreduction complete remission(CR),and cytoreduction non-CRgroups,respectively(P=0.051).Multivariate analyses demonstrated that pre-HSCT cytoreduction,older patient age,monosomal karyotype,and interval between diagnosis and HSCT were poor prognostic factors for RFS.In the subgroup analyses,BSC was associated with longer RFS compared to cytoreduction among the younger patients,those with international prognostic scoring system intermediate-2/high risk at diagnosis,and those with intermediate/poor cytogenetics.Conclusions:Different pre-HSCT therapies did not yield discrepant post-HSCT outcomes.No benefit in terms of post-HSCT outcomes were correlated with pre-HSCT cytoreduction in advanced MDS even for cytoreduction CR patients.Early referral to HSCT is
文摘BACKGROUND Academic studies have proved that anti-programmed death-1(PD-1)monoclonal antibodies demonstrated remarkable activity in relapsed/refractory classical Hodgkin lymphoma(cHL).However,most patients ultimately experienced failure or resistance.It is urgent and necessary to develop a novel strategy for relapsed/refractory cHL.The aim of this case report is to evaluate the combination approach of low-dose decitabine plus a PD-1 inhibitor in relapsed/refractory cHL patients with prior PD-1 inhibitor exposure.CASE SUMMARY The patient was a 27-year-old man who complained of enlarged right-sided cervical lymph nodes and progressive pain aggravation of the right shoulder over the past 3 mo before admission.Histological analysis of lymph node biopsy was suggestive of cHL.The patient experienced failure of eight lines of therapy,including multiple cycles of chemotherapy,PD-1 blockade,and anti-CD47 antibody therapy.Contrast-enhanced CT showed that the tumors of the chest and abdomen significantly shrunk or disappeared after three cycles of treatment with decitabine plus tislelizumab.The patient had been followed for 11.5 mo until March 2,2021,and no progressive enlargement of the tumor was observed.CONCLUSION The strategy of combining low-dose decitabine with tislelizumab could reverse the resistance to PD-1 inhibitors in patients with heavily pretreated relapsed/refractory cHL.The therapeutic effect of this strategy needs to be further assessed.
