Efficacy and Recurrence Factors of Veneclax Combined with Aza- citidine in the Treatment of Acute Myeloid Leukemia.
10.19746/j.cnki.issn.1009-2137.2023.06.009
- Author:
Xiang CHEN
1
;
Chun-Lan HUANG
1
Author Information
1. Stem Cell Laboratory, The Affiliated Hospital of Southwest Medical University; Luzhou 646000, Sichuan Province, China.
- Publication Type:Journal Article
- Keywords:
acute myeloid leukemia;
azacitidine;
recurrence;
treatment;
venetoclax
- MeSH:
Humans;
Remission Induction;
Prognosis;
Retrospective Studies;
Leukemia, Myeloid, Acute/genetics*;
Recurrence;
Azacitidine/therapeutic use*;
Chronic Disease;
Antineoplastic Combined Chemotherapy Protocols/therapeutic use*
- From:
Journal of Experimental Hematology
2023;31(6):1657-1662
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To observe the efficacy of veneclax combined with azacitidine in acute myeloid leukemia(AML) patients and explore the predictors of treatment response and recurrence.
METHODS:The clinical data of 30 AML patients who received venetecla combined with azacitidine in the Affiliated Hospital of Southwest Medical University from January 2021 to September 2022 were retrospectively analyzed, composite complete remission (CRc) rate, overall response rate(ORR), and disease free survival(DFS) of patients were observed.
RESULTS:After one course of trea- tment, CRc was 16 cases and ORR was 23/30. Patients with TP53 mutation had poor treatment response (P=0.009). After 1-2 courses, 25 patients reached CR/CRi. Finally, 24 patients who obtained CR/CRi were included to observe the duration of remission. 17 patients had relapse, with a median recurrence time of 3.9 (0.6-15.9) months. The Kaplan-Meier curve showed that MRD negative was a favorable factor for maintaining DFS status (HR=0.5647,95%CI:0.2179-1.464,P=0.007), while NRAS mutation was an adverse factor for maintaining DFS (HR=2.036,95%CI:0.6639-6.245,P=0.0003). Univariate combined multivariate cox regression analysis showed that NRAS mutation was an independent risk factor affecting DFS in patients (HR=5.569, P<0.05). In addition, the cases number of early recurrence in MRD negative group (n=8) and MRD non-negative group (n=9) was 0 and 5, respectively, the difference was statistically significant (P=0.012). There were 3 cases of early recurrence in the NRAS mutant group (n=4) and 2 cases in the NRAS wild-type group (n=13), the difference was statistically significant (P=0.022).
CONCLUSION:TP53 mutation is a predictor of poor response to veneclax in combination with azacitidine. With the conti-nuation of the combination chemotherapy regimen described above, NRAS mutation is an independent risk factor for DFS in patients. Moreover, the patients with non-negative MRD and NRAS mutations are at high risk of early recurrence.
