Yaşlı akut miyeloid lösemili hastalarda remisyon indüksiyonu olarak düşük doz sitozin arabinosid, azasitidin ve azasitidin venetoklaks kombinasyon tedavisinin karşılaştırılması

Abstract

Amaç: İleri yaş, kırılgan akut miyeloid lösemi (AML) hastalarının tedavisinde düşük yoğunluklu tedaviler yaygın olarak tercih edilmektedir. Bu çalışmada, düşük doz sitozin arabinosid (DDSA) veya azasitidin (AZA) veya AZA+venetoklaks (Ven) ile tedavi edilen ileri yaşlı AML hastalarının birinci siklus kemoterapi sonrası hematolojik iyileşme oranlarını ve genel sağkalımı karşılaştırmayı amaçladık. Yöntem: Doksan bir hasta geriye yönelik olarak incelendi. Bulgular: Çalışmaya DDSA ile tedavi edilen kırk bir hasta, AZA ile tedavi edilen 30 hasta ve AZA + Ven ile tedavi edilen 20 hasta dahil edildi. Tanıda ortanca yaş 70 idi. İlk kürden sonra nötrofil iyileşmesi gözlenen hastaların yüzdesi sırasıyla DDSA, AZA ve AZA +Ven tedavi gruplarında %27, %73 ve%50 idi. Trombosit iyileşmesi gözlenen hastaların oranı sırasıyla %60,%80,%70 idi. 1. kürün sonunda eritrosit transfüzyon bağımsızlığı DDSA hastaları için% 54, AZA hastaları için% 73 ve kombinasyon tedavisi için% 60 idi. AZA + Ven alan hastalarda genel sağkalım diğer tedavi gruplarına göre daha uzundu, ancak tedavinin ilk küründe grade 3-4 enfeksiyon bu hasta grubunda daha sık olarak bulundu. SONUÇ: Çalışmamıza göre, AZA ile tedavi edilen hastalar, DDSA ile tedavi edilen hastalardan daha uzun genel sağkalım ile daha iyi trombosit ve nötrofil iyileşme oranlarına sahipti, ancak AZA + Ven kombinasyonunda toplam genel sağkalım üstündü. Yaşlı AML hastalarında venetoklaks ile hipometile edici ajan kombinasyonu uzun sağkalım nedeniyle tercih edilebilecek bir tedavi seçeneğidir.

Keywords

• Akut myeloid lösemi
• azasitidin
• düşük doz sitozin arabinozid
• venetoklaks
• yaşlı hastalar

Comparison of low dose cytosine arabinoside, azacitidine and azacitidine venetoclax combination treatment as remission induction in elderly acute myeloid leukemia patients

Abstract

Aims: Low-intensity therapies are widely preferred in the treatment of advanced age, fragile acute myeloid leukemia (AML) patients. In this study, we aimed to compare hematological recovery rates after first cycle chemotherapy and overall survival for advanced aged AML patients treated with azacitidine (AZA) or low dose cytosine arabinoside (LDCA) or venetoclax (Ven) with AZA combination. Methods: Ninety-one patients were retrospectively analyzed. Results: Forty-one patients treated with LDCA, 30 patients treated with AZA and 20 patients treated with AZA+Ven were included in the study. Patients who received these three treatments and who achieved response and did not receive any other treatment during the follow-up period were included in the study. Median age at diagnosis was 70. The percentage of patients who achieved neutrophil recovery after the first cycle was 27%, 73% and 50% of the patients treated with LDCA, AZA and AZA+Ven respectively. The rate of patients who achieved platelet recovery was 60%, 80%, 70% respectively. Erythrocyte transfusion independency was 54% for LDCA patients, 73% for AZA patients and 60% for combination therapy. Overall survival was longer in patients receiving AZA+Ven than other treatment groups while grade 3-4 infections were more common in the first cycle of the treatment. Conclusion: According to our study, patients treated with AZA had better platelet and neutrophil recovery rates with also longer overall survival than patients treated with LDCA, but total overall survival was superior in AZA+Ven combination. Hypomethylating agents with venetoclax is a preferable treatment option in elderly AML patients.

Keywords

• Acute myeloid leukemia
• azacitidine
• low dose cytosine arabinoside
• venetoclax
• elderly patients

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