阿扎胞苷联合高三尖杉酯碱治疗老年慢性粒-单核细胞白血病的疗效和安全性分析

doi:10.3969/j.issn.1003-9198.2024.02.009

摘要/Abstract

摘要： 目的评估阿扎胞苷联合高三尖杉酯碱治疗老年慢性粒-单核细胞白血病(CMML)的疗效和安全性。方法纳入2018—2022年于我院确诊的40例老年CMML病人,按随机数表法分为试验组和对照组,每组20例。试验组接受阿扎胞苷联合高三尖杉酯碱治疗,对照组接受阿扎胞苷治疗,比较2组的疗效、安全性以及预后。结果共36例病人入组,试验组19例,对照组17例。试验组总缓解率(ORR)高于对照组(84.2%比52.9%,P=0.041)。2组病人不良反应发生率比较,差异无统计学意义(P>0.05)。试验组病人中位生存时间为33.8个月,明显高于对照组中位生存时间(21.2个月)(P<0.05)。结论阿扎胞苷联合高三尖杉酯碱方案治疗老年CMML安全有效。

关键词: 慢性粒-单核细胞白血病, 老年人, 高三尖杉酯碱, 阿扎胞苷

Abstract: Objective To evaluate the efficacy and safety of azacitidine combined with homoharringtonine in the treatment of chronic myelomonocytic leukemia(CMML) in the elderly. Methods A total of 40 elderly patients with CMML in our hospital from 2018 to 2022 were enrolled in this study. The patients were divided into the experimental group and the control group according to the random number table. The experimental group received azacitidine combined with homoharringtonine, and the control group received azacitidine regimen. The efficacy and safety of the two groups were analyzed and compared. Results Thirty-six patients were enrolled, with 19 cases in the experimental group and 17 cases in the control group. The overall relieve rate(ORR) of the experimental group was higher than that of the control group(82.4% vs 52.9%, P=0.041).The adverse effects showed no statistically significant differences between the two groups(P>0.05). The median survival time of the patients in the experimental group was 33.8 months, compared with 21.2 months in the control group(P<0.05). Conclusions Azacitidine combined with homoharringtonine is safe and effective in the treatment of CMML in the elderly.

Key words: chronic myelomonocytic leukemia, aged, homoharringtonine, azacitidine

中图分类号:

R 733.7

丰江舟, 孙晓星, 纪晓娟, 葛洪峰. 阿扎胞苷联合高三尖杉酯碱治疗老年慢性粒-单核细胞白血病的疗效和安全性分析[J]. 实用老年医学, 2024, 38(2): 145-148.

FENG Jiangzhou, SUN Xiaoxing, JI Xiaojuan, GE Hongfeng. Analysis of efficacy and safety of azacytidine combined with homoharringtonine in treatment of chronic myelomonocytic leukemia[J]. Practical Geriatrics, 2024, 38(2): 145-148.

参考文献

[1] PATNAIK M M, TEFFERI A.Chronic myelomonocytic leukemia:2018 update on diagnosis,risk stratification and management[J]. Am J Hematol, 2018, 93(6):824-840.
[2] 肖志坚. 骨髓增生异常综合征/骨髓增殖性肿瘤的诊断和治疗[J]. 中国实用内科杂志, 2018, 38(2): 93-97.
[3] 胡文青, 江滨. 慢性粒单核细胞白血病诊治进展[J]. 临床血液学杂志, 2019, 32(3): 242-246.
[4] LI J, HUANG Y, HOU Y, et al. High efficacy of azacitidine combined with homoharringtonine, idarubicin, and cytarabine in newly diagnosed patients with AML: a single arm, phase 2 trial[J]. Front Oncol, 2022, 12: 1069246.
[5] 中华医学会血液学分会白血病淋巴瘤学组. 慢性粒-单核细胞白血病诊断与治疗中国指南(2021年版)[J]. 中华血液学杂志, 2021, 42(1):5-9.
[6] 中华医学会血液学分会.骨髓增生异常综合征中国诊断与治疗指南(2019年版)[J]. 中华血液学杂志, 2019, 40(2):89-97.
[7] SAVONA M R, MALCOVATI L,KOMROKJI R, et al. An international consortium proposal of uniform response criteria for myelodysplastic/myeloproliferative neoplasms(MDS/MPN) in adults[J]. Blood, 2015, 125(12):1857-1865.
[8] ADÈS L, SEKERES M A, WOLFROMM A, et al. Predictive factors of response and survival among chronic myelomonocytic leukemia patients treated with azacitidine [J]. Leuk Res, 2013, 37(6):609-613.
[9] SANTINI V, ALLIONE B, ZINI G, et al. A phase II, multicentre trial of decitabine in higher-risk chronic myelomonocytic leukemia[J]. Leukemia, 2017, 32(2): 413-418.
[10] ALFONSO A, MONTALBAN-BRAVO G, TAKAHASHI K, et al. Natural history of chronic myelomonocytic leukemia treated with hypomethylating agents[J]. Am J Hematol, 2017, 92(7): 599-606.
[11] PLEYER L, LEISCH M,KOURAKLI A, et al. Outcomes of patients with chronic myelomonocytic leukaemia treated with non-curative therapies: a retrospective cohort study[J]. Lancet Haematol, 2021, 8(2): e135-e148.
[12] ZEIDAN A M, HU X, LONG J B, et al. Hypomethylating agent therapy use and survival in older patients with chronic myelomonocytic leukemia in the United States: a large population-based study[J]. Cancer, 2017, 123(19): 3754-3762.
[13] WIJERMANS P W, RUTER B, BAER M R, et al. Efficacy of decitabine in the treatment of patients with chronic myelomonocytic leukemia(CMML)[J]. Leuk Res, 2007, 32(4): 587-591.
[14] BRAUN T, ITZYKSON R, RENNEVILLE A, et al. Molecular predictors of response to decitabine in advanced chronic myelomonocytic leukemia: a phase 2 trial[J]. Blood, 2011, 118(14): 3824-3831.
[15] FRESNO M, JIMENEZ A, VAZQUEZ D. Inhibition of translation in eukaryoticsystems byharringtonine[J]. Eur J Biochem, 1977, 72(2):323-330.
[16] KURODA J,KAMITSUJI Y,KIMURA S, et al.Anti-myeloma effect of homoharringtonine with concomitant targeting of themyeloma-promoting molecules, mcl-1, XIAP, and beta-catenin[J]. Int J Hematol, 2008, 87(5):507-515.
[17] CHEN X J, ZHANG W N, CHEN B et al.Homoharringtonine deregulates MYC transcriptional expression by directly binding NF-κB repressing factor[J]. Proc Natl Acad Sci U S A, 2019, 116(6):2220-2225.
[18] TONG H, REN Y, ZHANG F, et al. Homoharringtonine affects the JAK2-STAT5 signal pathway through alteration of protein tyrosine kinase phosphorylation in acute myeloid leukemia cells[J]. Eur J Haematol, 2008, 81(4):259-266.