在加速和爆发阶段的MPN中,密集和非密集的爆发减少策略的结果
Marta B Davidson1, James A Kennedy1,2, Jose-Mario Capo-Chichi3
1Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
Blood advances
|January 3, 2024
概括
在加速或爆发阶段,强烈的爆发减缓策略显示了髓增殖性瘤 (MPN) 的更高的响应率. TP53和RAS突变,以及表现不佳的状态,预测MPN爆发阶段治疗的劣质结果.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
背景情况:
- 转变为加速或爆发阶段 (MPN-AP/BP) 的骨髓增殖性新生瘤 (MPN) 的预后不佳.
- 针对MPN-AP/BP的急性髓性白血病 (AML) 类型密集型和非密集型低甲基化剂治疗方案的有效性尚未得到充分证实.
研究的目的:
- 追溯分析MPN-AP/BP.患者中强化和非强化爆发减轻策略的疗效.
- 在这个患者群体中确定与治疗反应相关的因素.
主要方法:
- 对138名MPN-AP/BP患者进行了回顾性分析,这些患者接受了强化 (N=81) 或非强化 (N=57) 弹性减少策略的治疗.
- 使用了来自玛格丽特公主癌症中心的临床相关响应标准.
- 评估的应答率,包括完全缓解 (CR),不完全血液恢复的CRi和恢复到慢性期MPN (cMPN).
主要成果:
- 总体而言,最好的响应率为密集型策略的77%,非密集型策略的39%.
- 达诺鲁比辛+阿拉-C和FLAG-IDA/NOVE-HiDAC的整体反应率相似,但达诺鲁比辛+阿拉-C需要更多的第二次诱导.
- 大多数反应是对cMPN的逆转 (66%),CR (30%) 和CRi (4%) 不太常见.
- TP53和RAS路径突变以及较差的性能状态与较差的治疗反应有关,特别是在密集治疗的患者中.
结论:
- 与非密集方法相比,密集的爆炸减轻策略在MPN-AP/BP中实现了更高的响应率.
- 恢复到慢性阶段的MPN是最常见的反应.
- 遗传突变 (TP53,RAS) 和表现不佳是MPN-AP/BP治疗反应的负预后因素.
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