Analysis of Curative Efficacy of Azacitidine Combined with Venetoclax in Elderly Patients with Newly Diagnosed Acute Myeloid Leukemia
Objective To evaluate the clinical efficacy of combining azacitidine with the Bcl-2 inhibitor venetoclax in treating elderly patients with newly diagnosed acute myeloid leukemia(AML).Methods Retrospective analysis was conducted on clinical data from 47 elderly AML patients admitted to the First Affiliated Hospital of Jinzhou Medical University between May 2020 and May 2023.All 47 patients were treated with azacytidine combined with venetoclax.The complete response(CR)rate and hematological complete response with incomplete recovery(CRi)rate of the 47 elderly patients were observed,and the overall response rate(ORR)and the negative conversion rate of minimal residual lesion(MRD)of the 47 patients were observed.The factors affecting the efficacy and prognosis of the patients were analyzed,and the safety of the scheme was evaluated.Results Objective response was ob-served in35 of the47 AML patients,of which 20 cases(57.10％)achieved CR,12 cases(42.50％)achieved complete remis-sion(CR),4 cases(8.50％)achieved CRi,and 4 cases(8.50％)achieved partial remission(PR)within one course of treat-ment.The CR/CRi rateof47 patientswas51.00％and ORRwas59.50％.Amongpatientswith CRor CRi,17 patients(53.10％)achieved MRD-negative after≤2 courses of azacitidine combined with venetoclax.In addition,univariate prognostic analysis was per-formed according to FAB classification,age,white blood cell count at initial diagnosis,proportion of bone marrow original cells before initial treatment,and types of some special gene mutations.The results showed that patients aged≥70 years(r=0.035),with no TP53 mutation(r=0.031),and with NPM1 with a high FLT3-ITD mutation(r=0.043)had a better response when treated with azacytidine in combination with venetoclax.Conclusion Azacytidine combined with venetoclax is safe and effective in the treatment of elderly patients with newly diagnosed AML.Age,high NPM1 with FLT3-ITD mutation,and TP53 mutation were predictors of out-come.The proportion of bone marrow original cells prior to initial treatment,presence or absence of TP53 mutations,and achievement of CR or CRi were independent risk factors for survival.
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