医学
内科学
造血干细胞移植
移植
养生
累积发病率
来那度胺
耐受性
髓系白血病
中性粒细胞减少症
发热性中性粒细胞减少症
肿瘤科
胃肠病学
外科
不利影响
化疗
多发性骨髓瘤
作者
Yimei Feng,Ting Chen,Yun Zhang,Yong Han,Ping Wang,Lu Wang,Kaniel Cassady,Zhongmin Zou,Yuqing Liu,Lu Zhao,Lei Gao,Xi Zhang,Peiyan Kong
标识
DOI:10.3389/fimmu.2023.1182251
摘要
Introduction While allogeneic hematopoietic stem cell transplantation (allo-HSCT) can be a curative regimen for acute myeloid leukemia (AML), relapse of AML remains a serious risk post-transplantation. Once relapsed, salvage options are limited and management of AML is difficult. Here we designed a prospective study to examine the efficacy and tolerability of maintenance therapy with azacytidine (AZA) plus low-dose lenalidomide (LEN) to prevent relapse after allo-HSCT for AML patients (ChiCTR2200061803). Methods AML patients post-allo-HSCT were treated with AZA (75 mg/m 2 for 7 days), followed by LEN (5 mg/m 2 , day 10-28), and a 4-week resting interval, which was defined as one treatment cycle. A total of 8 cycles was recommended. Results 37 patients were enrolled, 25 patients received at least 5 cycles, and 16 patients finished all 8 cycles. With a median follow-up time of 608 (43-1440) days, the estimated 1-year disease free survival (DFS) was 82%, cumulative incidence of relapse (CIR) was 18%, and overall survival (OS) was 100%. Three patients (8%) had grade 1-2 neutropenia without fever; one patient developed grade 3-4 thrombocytopenia and minor subdural hematoma; 4/37 patients (11%) developed chronic GVHD with a score of 1-2, without requiring systemic treatment; No patient developed acute GVHD. After AZA/LEN prophylaxis, increasing numbers of CD56 + NK and CD8 + T, and decreasing of CD19 + B cells were observed. Discussion Azacitidine combined with low-dose lenalidomide was observed to be an effective relapse prophylaxis option after allo-HSCT in AML patients, and can be administered safely without significantly increasing the risk of GVHD, infection and other AEs. Clinical Trial Registration www.chictr.org , identifier ChiCTR2200061803.
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