文章：

剂量减量的FLA-IDA联合维奈托克是复发难治性急性髓系白血病（R/R AML）有效且安全的挽救性治疗方案

Dose-Reduced FLA-IDA in Combination with Venetoclax Is an Effective and Safe Salvage Therapy in Relapsed and Refractory Acute Myeloid Leukemia (R/R AML)

原文发布日期：19 November 2024

DOI: 10.3390/cancers16223872

类型: Article

开放获取: 是

英文摘要：

Background: Despite the development of targeted therapies in first-line AML, complete remissions (CR) cannot be achieved in 30–40%, and relapse rates remain high. In R/R AML the intensive treatment regimen of fludarabine, cytarabine, idarubicin combined with venetoclax (FLA-VIDA) showed improved remission rates compared to FLA-IDA. In this retrospective single-center analysis, we investigated the efficacy and safety of dose-reduced FLA-IDA with and without venetoclax to minimize the risk of infectious complications and excessive myelosuppression; Methods: Between 2011 and 2023, 89 R/R AML patients were treated with dose-reduced FLA-IDA (fludarabine 30 mg/m2day 1–4, cytarabine 2000 mg/m2day 1–4, idarubicin 10 mg/m2day 1 + 4). From 2019 onwards, venetoclax was added (day 1 100 mg, day 2 200 mg, day 3–14 400 mg); Results: Significantly improved response rates were observed with 60.0% vs. 38.8% CR/CRi (p= 0.0297) and 74.5% vs. 47.3% (p= 0.032) CR/CRi/MLFS for FLA-VIDA vs. FLA-IDA. Further, with FLA-VIDA significantly improved event-free survival (EFS) was observed (p= 0.026). Overall survival (OS) was similar in FLA-VIDA and FLA-IDA treated patients. The most common treatment-related toxicities were hematological adverse events, but they were comparable between groups. The time to neutrophil and platelet recovery were similar in responding patients treated with FLA-VIDA vs. FLA-IDA; Conclusions: Dose-reduced FLA-VIDA significantly improved response rates without increases in toxicity, showing promise for an improved R/R AML treatment.

摘要翻译： 

背景：尽管急性髓系白血病（AML）的一线靶向治疗已取得进展，但仍有30-40%的患者无法达到完全缓解（CR），且复发率居高不下。在复发/难治性AML（R/R AML）治疗中，氟达拉滨、阿糖胞苷、伊达比星联合维奈托克（FLA-VIDA）强化治疗方案相较于FLA-IDA方案显示出更高的缓解率。本项回顾性单中心研究旨在评估减量FLA-IDA方案联合或不联合维奈托克的疗效与安全性，以降低感染并发症及过度骨髓抑制风险。 方法：2011年至2023年间，89例R/R AML患者接受减量FLA-IDA方案治疗（氟达拉滨30 mg/m²第1-4天，阿糖胞苷2000 mg/m²第1-4天，伊达比星10 mg/m²第1、4天）。自2019年起，联合维奈托克治疗（第1天100 mg，第2天200 mg，第3-14天400 mg）。 结果：FLA-VIDA组与FLA-IDA组相比，完全缓解/血细胞计数未完全恢复的完全缓解（CR/CRi）率显著提高（60.0% vs. 38.8%，p=0.0297），CR/CRi/形态学无白血病状态（MLFS）率亦显著提升（74.5% vs. 47.3%，p=0.032）。此外，FLA-VIDA组无事件生存期（EFS）显著改善（p=0.026），但两组总生存期（OS）无显著差异。治疗相关毒性以血液学不良事件最为常见，但组间发生率相当。在获得缓解的患者中，FLA-VIDA组与FLA-IDA组的中性粒细胞与血小板恢复时间相近。 结论：减量FLA-VIDA方案在不增加毒性的前提下显著提高了缓解率，为改善R/R AML治疗提供了新方向。

原文链接：

Dose-Reduced FLA-IDA in Combination with Venetoclax Is an Effective and Safe Salvage Therapy in Relapsed and Refractory Acute Myeloid Leukemia (R/R AML)