■难治性/复发性急性髓细胞性白血病(R/RAML)即使在异基因造血干细胞移植后也不能令人满意。长期生存率主要受诱导治疗后完全缓解(CR)率的影响。
■使用新的诱导疗法(硼替佐米,高三尖杉酯碱,和阿糖胞苷[BHA])用于R/RAML患者。
■我们招募了21例R/RAML患者(中位年龄,42[范围,30-62]年),谁接受BHA用于缓解诱导(硼替佐米,第1天和第4天1.3毫克/平方米/天;高三尖杉酯碱,4mg/m2/天,持续5天,和阿糖胞苷,1.5g/m2/天,持续5天)。评估CR和不良事件。
■经过一个过程的BHA,CR/CRi和部分缓解率分别为38.1%和14.3%,分别,21例患者的总缓解率(ORR)为52.4%。21例患者中有9例携带FLT3-ITD或FLT3-TKD突变,与无FLT3突变的R/RAML相比,CR/CRi或ORR为66.7%(P=0.03)。诱导治疗后,巩固化疗或异基因造血干细胞移植导致所有患者的1年总生存率为27.8%。1个疗程BHA后达到CR/CRi的8例患者的1年无复发生存率为50%。在感应过程中,非血液学不良事件(3/4级)通常为感染(90.5%),低钾血症(14.4%),低钙血症(14.3%),粘膜炎(9.5%)。在获得CR的患者中,中性粒细胞计数>0.5×109/L和血小板计数>20×109/L的中位时间分别为15(13-17)天和13(13-18)天,分别。
■BHA化疗方案作为R/RAML的诱导治疗是安全和可耐受的,特别是FLT3突变。在进一步研究中,较高的CR/CRi率将为确定BHA对携带FLT3突变的AML患者的潜在有效性提供线索。
■https://www.chictr.org.cn/,标识符ChiCTR2000029841。
UNASSIGNED: Refractory/relapsed acute myeloid leukemia (R/R AML) has unsatisfactory outcomes even after allogeneic hematopoietic stem cell transplantation. Long-term survival is mainly influenced by complete remission (CR) rates after induction therapies.
UNASSIGNED: To investigate CR/CR with incomplete hematologic recovery (CRi) rates and adverse events with a new induction therapy (bortezomib, homoharringtonine, and cytarabine [BHA]) for patients with R/R AML.
UNASSIGNED: We enrolled 21 patients with R/R AML (median age, 42 [range, 30-62] years), who received BHA for remission induction (bortezomib, 1.3 mg/m2/day on days 1 and 4; homoharringtonine, 4 mg/m2/day for 5 days, and cytarabine, 1.5 g/m2/day for 5 days). CR and adverse events were assessed.
UNASSIGNED: After one course of BHA, the CR/CRi and partial remission rates were 38.1% and 14.3%, respectively, with an overall response rate (ORR) of 52.4% in 21 patients. 9 of 21 patients harbored FLT3-ITD or FLT3-TKD mutations, and achieved either CR/CRi or ORR of 66.7% (P=0.03) by comparison with that in R/R AML without FLT3 mutation. After induction therapy, consolidation chemotherapy or allogeneic hematopoietic stem cell transplantation led to a one-year overall survival of 27.8% in all patients. One-year relapse-free survival was 50% in 8 patients who had achieved CR/CRi after one course of BHA. During induction, non-hematologic adverse events (grade 3/4) commonly were infection (90.5%), hypokalemia (14.4%), hypocalcemia (14.3%), and mucositis (9.5%). In patients achieving CR, the median time to neutrophil count >0.5×109/L and time to platelet count >20×109/L were 15 (13-17) days and 13 (13-18) days, respectively.
UNASSIGNED: BHA chemotherapy regimen was safe and tolerable to serve as an induction therapy for R/R AML, particularly with FLT3 mutation. The higher CR/CRi rate will give a clue to determine a potentialeffectiveness of BHA for AML patients carrying FLT3 mutation in a further investigation.
UNASSIGNED: https://www.chictr.org.cn/, identifier ChiCTR2000029841.