Venetoclax with decitabine vs intensive chemotherapy in acute myeloid leukemia: A propensity score matched analysis stratified by risk of treatment-related mortality.
Venetoclax with decitabine vs intensive chemotherapy in acute myeloid leukemia: A propensity score matched analysis stratified by risk of treatment-related mortality.
复制标题
维尼替克联合地西他滨与强化化疗治疗急性髓系白血病：一项按治疗相关死亡风险分层的倾向性评分匹配分析。
DOI：
10.1002/ajh.26061
复制
发表时间：
2021-03-01
影响因子：
12.8
通讯作者：
Konopleva MY
中科院分区：
文献类型：
--
作者：
Maiti A;Qiao W;Sasaki K;Ravandi F;Kadia TM;Jabbour EJ;Daver NG;Borthakur G;Garcia-Manero G;Pierce SA;Montalbano KS;Pemmaraju N;Naqvi K;Ohanian M;Short NJ;Alvarado Y;Takahashi K;Yilmaz M;Jain N;Kornblau SM;Andreeff M;Bose P;Ferrajoli A;Issa GC;Masarova L;Thompson PA;Rausch CR;Ning J;Kantarjian HM;DiNardo CD;Konopleva MY
低甲基化药物（HMA）与维奈托克是老年/不适合急性髓性白血病（AML）患者的新标准。然而，尚不清楚HMA与Venetoclax在“适合”或“不适合”IC患者中与强化化疗（IC）相比如何。我们比较了接受10天地西他滨联合维奈托克（DEC 10-VEN）与IC治疗的新诊断AML老年患者的结局。DEC 10-VEN包括每日一次维奈托克和地西他滨20 mg/m2，诱导10天，地西他滨巩固5天。IC队列接受含阿糖胞苷≥1 g/m2/d的方案。使用经验证的治疗相关死亡率评分（TRMS）对TRM伴IC的高风险或低风险患者进行分类。倾向评分用于匹配患者，以尽量减少偏倚。DEC 10-VEN队列（n=85）的中位年龄为72岁（范围63-89），28%的患者处于TRM伴IC的高风险中。对照IC组（n=85）在基线特征方面非常匹配。与IC相比，DEC 10-VEN与显著更高的CR/CRi相关（81%对52%，p<.001），复发率较低（34%对56%，p= 0.01），30天死亡率（1%对24%，p<0.01），和更长的总生存期（OS; 12.4对4.5个月，HR=0.48，95%CI 0.29-0.79，p<0.01）。在TRM高风险和低风险患者中，与IC相比，DEC 10-VEN显示出显著更高的CR/CRi、更低的30天死亡率和更长的OS。TRM高风险和低风险患者的结局与DEC 10-VEN相当。DEC 10-VEN在老年AML患者中提供了优于IC的结局，特别是在TRM高风险患者中。
Hypomethylating agents (HMA) with venetoclax is a new standard for older/unfit patients with acute myeloid leukemia (AML). However, it is unknown how HMA with venetoclax compare to intensive chemotherapy (IC) in patients who are ‘fit’ or ‘unfit’ for IC. We compared outcomes of older patients with newly diagnosed AML receiving 10-day decitabine with venetoclax (DEC10-VEN) versus IC. DEC10-VEN consisted of daily venetoclax with decitabine 20 mg/m2 for 10-days for induction and decitabine for 5-days as consolidation. The IC cohort received regimens containing cytarabine ≥1 g/m2/d. A validated treatment-related mortality score (TRMS) was used to classify patients at high- or low-risk for TRM with IC. Propensity scores were used to match patients to minimize bias. Median age of the DEC10-VEN cohort (n=85) was 72 years (range 63–89) and 28% patients were at high-risk of TRM with IC. The comparator IC group (n=85) matched closely in terms of baseline characteristics. DEC10-VEN was associated with significantly higher CR/CRi compared to IC (81% vs 52%, p<.001), and lower rate of relapse (34% vs 56%, p=.01), 30-day mortality (1% vs 24%, p<.01), and longer overall survival (OS; 12.4 vs 4.5 months, HR=0.48, 95%CI 0.29–0.79, p<.01). In patients at both at high- and low-risk of TRM, DEC10-VEN showed significantly higher CR/CRi, lower 30-day mortality, and longer OS compared to IC. Patients at both high- and low-risk of TRM had comparable outcomes with DEC10-VEN. DEC10-VEN offers superior outcomes compared to IC in older patients with AML, particularly in patients at high-risk of TRM.
登录
查看更多内容
DOI：
10.1016/s2352-3026(20)30210-6
发表时间：
2020-10
期刊：
The Lancet. Haematology
影响因子：
--
作者：
DiNardo CD;Maiti A;Rausch CR;Pemmaraju N;Naqvi K;Daver NG;Kadia TM;Borthakur G;Ohanian M;Alvarado Y;Issa GC;Montalban-Bravo G;Short NJ;Yilmaz M;Bose P;Jabbour EJ;Takahashi K;Burger JA;Garcia-Manero G;Jain N;Kornblau SM;Thompson PA;Estrov Z;Masarova L;Sasaki K;Verstovsek S;Ferrajoli A;Weirda WG;Wang SA;Konoplev S;Chen Z;Pierce SA;Ning J;Qiao W;Ravandi F;Andreeff M;Welch JS;Kantarjian HM;Konopleva MY
通讯作者：
Konopleva MY
影响因子：
6.5
作者：
Giles, Francis J.;Borthakur, Gautam;Kantarjian, Hagop
通讯作者：
Kantarjian, Hagop
影响因子：
45.3
作者：
Walter, Roland B.;Othus, Megan;Estey, Elihu H.
通讯作者：
Estey, Elihu H.
影响因子：
1.3
作者：
Jupiter, Daniel C.
通讯作者：
Jupiter, Daniel C.
影响因子：
7.5
作者：
Maiti, Abhishek;Kantarjian, Hagop M.;Cortes, Jorge E.
通讯作者：
Cortes, Jorge E.