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在AML患者中低剂量cytarabine和venetoclax的风险分层不符合强化化疗法的患者

Andrew H Wei¹, Panayiotis Panayiotidis², Pau Montesinos³

¹Peter MacCallum Cancer Centre, The Royal Melbourne Hospital and Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.

|November 21, 2025

概括

新的研究表明,现有的急性髓性白血病 (AML) 风险分类对于低剂量cytarabine加上venetoclax治疗是不够的. 复杂的型和TP53突变确定了接受这种治疗的AML患者的不良预后.

科学领域:

血液学血液学血液学
在瘤学瘤学.
分子生物学分子生物学

背景情况:

预后风险分类对于急性髓性白血病 (AML) 治疗选择至关重要.
欧洲白血病网络 (ELN) 的分类 (2017年,2022年) 已为密集化疗建立,但对于像阿扎西提丁加维尼托克拉克斯这样的不那么密集的疗法效果较差.
开发了一个4基因分类器,用于azacitidine和venetoclax,根据预测的治疗益处对患者进行分层.

研究的目的:

评估ELN 2022标准和4基因阿扎西提丁-维尼托克拉克斯分类器在接受低剂量细胞因子 (LDAC) 加维尼托克拉克斯的患者的预后效用.
确定新的分子和细胞遗传标记,预测用LDAC加venetoclax治疗的AML患者的结果.

主要方法:

对139名用LDAC加上venetoclax治疗的患者队列的分析.
评估ELN 2022标准和用于预后分层的4基因分类器.
数据驱动和经验分析以确定相关的分子/细胞遗传风险标志物,包括复杂的型和TP53突变.

主要成果:

无论是ELN 2022标准还是4基因分类器,在LDAC和venetoclax队列中都没有足够分层的预后.
同时患有NPM1和FLT3-ITD/RAS变异的患者表现出良好的结果 (92%CR/CRi,中位数OS为29.67个月).
复杂的型和/或TP53突变被确定为显著的负预后标志物 (25%CR/CRi,3.48个月的中位数生存期).
没有这些不良预后标记的患者有更好的结果 (67%CR/CRi,平均寿命14.92个月).

结论:

现有的AML预后模型 (ELN 2022,4基因分类器) 不足以对LDAC加venetoclax的患者进行分层.
复杂的型和TP53突变是基于venetoclax的疗法的关键负预后指标.
分子分类对于在接受基于venetoclax的治疗方案的AML患者治疗结果的定义至关重要.

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