Efficacy and safety of venetoclax combined with azacitidine versus CAG regimen combined with decitabine in elderly patients with relapsed acute myeloid leukemia
10.3760/cma.j.cn112138-20210406-00261
- VernacularTitle:维奈克拉联合阿扎胞苷与地西他滨联合预激方案治疗老年复发急性髓系白血病的疗效及安全性比较的初步观察
- Author:
Peng WANG
1
;
Luwei ZHANG
;
Shenqi LU
;
Tanzhen WANG
;
Meng SHAN
;
Jinyan XIAO
;
Hong TIAN
;
Xiao MA
;
Yang XU
;
Depei WU
Author Information
1. 苏州大学附属第一医院血液科 国家血液系统疾病临床医学研究中心 江苏省血液研究所 卫生部血栓与止血重点实验室 苏州大学造血干细胞移植研究所, 苏州215006
- Keywords:
Venetoclax;
Acute myeloid leukemia;
Recurrence;
Aged;
Treatment outcome
- From:
Chinese Journal of Internal Medicine
2022;61(2):157-163
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the efficacy and safety of venetoclax (VEN) combined with azacitidine (AZA) versus CAG regimen combined with decitabine (DAC) in elderly patients with relapsed acute myeloid leukemia (AML).Methods:From January 2018 to August 2020, the clinical data of forty-five elderly patients with relapse AML at the First Affiliated Hospital of Soochow University were retrospectively analyzed, including 31 males and 14 females. The median age was 66 (60-80) years old. Eighteen patients were administrated with VEN and AZA, while the other 27 were in CAG with DAC. The complete remission (CR) rate, partial remission (PR) rate, total remission rate (ORR), adverse events and overall survival (OS) were compared between the two groups.Results:At the end of the treatment, the ORR in VEN with AZA group was 77.8% (14/18); including 11 CR and 3 PR. In CAG with DAC group, the ORR was 37.0% (10/27); including 8 CR and 2 PR ( P=0.007). Subgroup analysis suggested that VEN with AZA had a higher ORR in patients stratified as intermediate and poor-risk ( P=0.013) or with DNA methylation mutations ( P=0.007). Main adverse events in both groups were bone marrow suppression, infections, nausea and vomiting, anorexia and fatigue. Grade Ⅲ-Ⅳ cytopenia developed in lower incidence of VEN with AZA group, such as leukopenia (66.7% vs. 100%, P=0.002), anemia (50.0% vs. 92.6%, P=0.002), thrombocytopenia (72.2% vs. 96.3%, P=0.031) and neutropenia (61.1% vs. 92.6%, P=0.014). In addition, less grade Ⅲ-Ⅳ infections occurred in VEN with AZA group (66.7% vs. 33.3%, P=0.028), as well as grade Ⅲ-Ⅳ gastrointestinal events (40.7% vs. 11.1%, P=0.032), grade Ⅲ-Ⅳ fatigue (55.6% vs.11.1%, P=0.003) compared with CAG with DAC group. The 1-year OS in VEN with AZA group versus CAG with DAC group was 42.9% and 31.6% respectively ( P=0.150). Conclusion:VEN combined with AZA proves favorable efficacy and tolerablity in elderly patients with relapsed AML.
