引用本文: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.维奈克拉联合阿扎胞苷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后复发的临床疗效及安全性分析[J].中国临床新医学,2023,16(11):1130-1135.
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维奈克拉联合阿扎胞苷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后复发的临床疗效及安全性分析
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
530021 南宁,广西医科大学第一附属医院血液内科
摘要:
[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(77~1 099)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。
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
DOI:10.3969/j.issn.1674-3806.2023.11.06
分类号:
基金项目:广西医疗卫生适宜技术开发与推广应用项目(编号:S2018009)
Analysis on the clinical efficacy and safety of venetoclax combined with azacitidine and donor lymphocyte infusion in treatment of the relapse of myeloid malignancies after allogeneic hematopoietic stem cell transplantation
SHI Ling-ling, WU Mei-qing, LIU Lian-jin, et al.
Department of Haematology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
Abstract:
[Abstract] 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(77-1 099)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.
Key words:  Allogeneic hematopoietic stem cell transplantation(allo-HSCT)  Relapse  Myeloid malignancies  Venetoclax  Azacitidine  Donor lymphocyte infusion