Less is more: An analysis of venetoclax and hypomethylating agent post-induction treatment modifications in AML

IF 2.1 4区 医学 Q3 HEMATOLOGY
Stephanie Boisclair , Edward Zhou , Phyu Naing , Richa Thakur , Erin Jou , Bradley Goldberg , Douglas E. Gladstone , Steven L. Allen , Jonathan E. Kolitz , David W. Chitty
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引用次数: 0

Abstract

Venetoclax (Ven) combined with a hypomethylating agent (HMA) enhances survival in elderly/unfit acute myeloid leukemia (AML) patients, yet often necessitates regimen modifications due to intolerance. However, it is unclear how these modifications affect patient outcome. This retrospective cohort study evaluates the impact of post-induction HMA/Ven regimen modifications on disease progression and survival. This study reviewed 142 AML patients treated with HMA/Ven within the Northwell Health System from January 2019 to December 2022. To assess the impact of post-induction regimen modifications, patients were grouped according to median days between cycles (≤34 or ≥35 days cycle intervals) and median Ven days per cycle (≤14 or ≥15 days/cycle) based on only cycle 3 and beyond. Kaplan-Meier and Cox proportional hazard regression analyses were employed for univariate and multivariate assessments, respectively. There was no significant difference in median progression-free survival (mPFS)(11.6 vs 11.8 months, p = 0.73) or median overall survival (mOS)(15.1 vs 21.8 months, p = 0.16) between cycle interval groups. However, there was a clinically and statistically significant advantage in mPFS (15.8 vs 8.7 months, p = 0.01) and mOS (24.7 vs 11.3 months, p = 0.006) for patients with a median of ≤14 Ven days/cycle compared to ≥15 Ven days/cycle. Multivariate analysis demonstrated that ≤14 days of Ven for cycle 3 and beyond was an independent predictor of decreased mortality (HR 0.18, CI 0.07–0.48, p = 0.0007). Extended cycle intervals did not adversely affect mortality while reduced Ven duration per cycle post-induction was associated with improved survival in elderly AML patients.

Abstract Image

少即是多:急性髓细胞性白血病中venetoclax和低甲基化药物诱导后治疗调整分析
Venetoclax(Ven)与低甲基化药物(HMA)联用可提高老年/不适合急性髓性白血病(AML)患者的生存率,但由于不耐受,往往需要对治疗方案进行调整。然而,目前还不清楚这些调整如何影响患者的预后。这项回顾性队列研究评估了诱导后 HMA/Ven 方案调整对疾病进展和生存期的影响。本研究回顾了 2019 年 1 月至 2022 年 12 月期间诺斯韦尔医疗系统内接受 HMA/Ven 治疗的 142 例急性髓细胞白血病患者。为评估诱导后治疗方案修改的影响,仅根据第3周期及以上,按照周期间中位天数(周期间隔≤34天或≥35天)和每个周期中位Ven天数(≤14天或≥15天/周期)对患者进行分组。单变量和多变量评估分别采用卡普兰-梅耶尔和考克斯比例危险回归分析。周期间隔组间的中位无进展生存期(mPFS)(11.6 个月 vs 11.8 个月,p = 0.73)或中位总生存期(mOS)(15.1 个月 vs 21.8 个月,p = 0.16)无明显差异。然而,与中位数≥15 Ven天/周期相比,中位数≤14 Ven天/周期的患者在中位总生存期(mPFS)(15.8个月 vs 8.7个月,p = 0.01)和中位总生存期(mOS)(24.7个月 vs 11.3个月,p = 0.006)方面具有显著的临床和统计学优势。多变量分析表明,第 3 个周期及以后的 Ven 天数≤14 天是死亡率降低的独立预测因素(HR 0.18,CI 0.07-0.48,p = 0.0007)。延长周期间隔不会对死亡率产生不利影响,而缩短诱导后每个周期的Ven持续时间与老年AML患者生存率的提高有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Leukemia research
Leukemia research 医学-血液学
CiteScore
4.00
自引率
3.70%
发文量
259
审稿时长
1 months
期刊介绍: Leukemia Research an international journal which brings comprehensive and current information to all health care professionals involved in basic and applied clinical research in hematological malignancies. The editors encourage the submission of articles relevant to hematological malignancies. The Journal scope includes reporting studies of cellular and molecular biology, genetics, immunology, epidemiology, clinical evaluation, and therapy of these diseases.
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