维奈克拉联合阿扎胞苷治疗原发性骨髓纤维化转急性巨核细胞白血病1例并文献复习

魏小芳; 冯友繁; 丁国胜; 伏媛; 陈阳; 张启科

doi:10.16766/j.cnki.issn.1674-4152.003441

维奈克拉联合阿扎胞苷治疗原发性骨髓纤维化转急性巨核细胞白血病1例并文献复习

doi: 10.16766/j.cnki.issn.1674-4152.003441

1.
甘肃省人民医院血液科, 甘肃兰州 730000
2.
甘肃省人民医院检验科

基金项目:

甘肃省人民医院院内科研基金项目 18GSSY4-34

甘肃省自然科学基金项目 22JR5RA660

详细信息

通讯作者:
张启科，E-mail: zqk05@163.com

中图分类号: R551.3 R733.7
计量
- 文章访问数: 131
- HTML全文浏览量: 60
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2023-01-02
- 网络出版日期: 2024-05-27

Venetoclax combined with azacitidine in treatment of acute megakaryoblastic leukemia transformed from primary myelofibrosis: report of 1 case and review of literature

1.
Department of Hematology, Gansu Provincial Hospital, Lanzhou, Gansu 730000, China

摘要

摘要: 本文回顾性分析甘肃省人民医院1例应用维奈克拉联合阿扎胞苷治疗的原发性骨髓纤维化转化的急性单核细胞白血病老年患者的临床资料，并复习相关文献。本例患者系72岁, 男性，诊断原发性骨髓纤维化经芦可替尼治疗2年后转化为急性单核细胞白血病，遂给予维奈克拉联合阿扎胞苷治疗。患者第1疗程后部分缓解，临床症状改善明显。第2疗程后，患者完全缓解，流式微小残留病灶阴性，但持续粒细胞缺乏状态长达45 d，最终因感染死亡。
- 维奈克拉 /
- 阿扎胞苷 /
- 原发性骨髓纤维化 /
- 急性巨核细胞白血病
Abstract: We retrospectively analyzed the clinical data of an elderly patient of acute megakaryoblastic leukemia transformed from primary myelofibrosis treated with venetoclax combined with azacitidine in Gansu Provincial People' s Hospital and reviewed the relevant literature. This patient, a 72-year-old man, was diagnosed with primary myelofibrosis and was transformed to acute megakaryoblastic leukemia after 2 years of treatment with ruxolitinib, then given venetoclax combined with azacitidine. After the first course of treatment, the patient had partial remission of bone marrow and clinical improvement significantly. After the second course of treatment, although the bone marrow had complete remission and flow minimal residual disease (MRD) was negative, agranulocytosis persisted for up to 45 days and finally died due to infection.
- Venetoclax /
- Azacitidine /
- Primary myelofibrosis /
- Acute megakaryoblastic leukemia

HTML全文

图 1 1例原发性骨髓纤维化转急性巨核细胞白血病患者骨髓细胞形态学结果(瑞氏染色，×1 000)

Figure 1. Morphological phenotypes of bone marrow cells in a patient with acute megakaryocytic leukemia transformed from primary myelofibrosis (Wright' s staining, ×1 000)

下载: 全尺寸图片幻灯片

图 2 1例原发性骨髓纤维化转急性巨核细胞白血病(AMKL)患者染色体核型

Figure 2. Chromosomal karyotype analysis in a patient with acute megakaryocytic leukemia (AMKL) transformed from primary myelofibrosis

下载: 全尺寸图片幻灯片

参考文献(24)

[1]	GUPTA V, WOLLESCHAK D, HASSELBALCH H, et al. Safety and efficacy of the combination of sonidegib and ruxolitinib in myelofibrosis: a phase 1b/2 dose finding study[J]. Blood Adv, 2020, 4(13): 3063-3071. doi: 10.1182/bloodadvances.2019001212
[2]	HOW J, HOBBS G S. A practical guide for using myelofibrosis prognostic models in the clinic[J]. J Natl Compr Canc Netw, 2020, 18(9): 1271-1278. doi: 10.6004/jnccn.2020.7557
[3]	SHAHIN O A, CHIFOTIDES HT, BOSE P, et al. Accelerated phase of myeloproliferative neoplasms[J]. Acta Haematol, 2021, 144(5): 484-499. doi: 10.1159/000512929
[4]	MCNULTY M, CRISPINO J D. Acute megakaryocytic leukemia[J]. Csh Perspect Med, 2020, 10(2): a034884-a034899. DOI: 10.1101/cshperspect.a034884.
[5]	ESTEY E, KARP J E, EMADI A, et al. Recent drug approvals for newly diagnosed acute myeloid leukemia: gifts or a Trojan horse?[J]. Leukemia, 2020, 34(3): 671-681. doi: 10.1038/s41375-019-0704-5
[6]	VALLAPUREDDY R R, MUDIREDDY M, PENNA D, et al. Leukemic transformation among 1306 patients with primary myelofibrosis: risk factors and development of a predictive model[J]. Blood Cancer J, 2019, 9(2): 12-19. doi: 10.1038/s41408-019-0175-y
[7]	TEFFERI A, LASHO T L, JIMMA T, et al. One thousand patients with primary myelofibrosis: the Mayo clinic experience[J]. Mayo Clin Proc, 2012, 87(1): 25-33. doi: 10.1016/j.mayocp.2011.11.001
[8]	PASQUIER F, CABAGNOLS X, SECARDIN L, et al. Myeloproliferative neoplasms; JAK2 signaling pathway as a central target for therapy[J]. Clin Lymphoma Myeloma Leuk, 2014, 14(S3): S23-35.
[9]	尹春荣, 翁巍, 侯海珠, 等. JAK2V617F 基因突变与BCR/ABL阴性骨髓增殖性肿瘤的临床相关性分析[J]. 中华全科医学, 2016, 14(8): 1299-1301. doi: 10.16766/j.cnki.issn.1674-4152.2016.08.017 YIN C R, WENG W, HOU H Z, et al. JAK2V617F mutation and myeloproliferative neoplasms with BCR/ABL negative gene clinical correlation analysis[J]. Chinese Journal of General Practice, 2016, 14(8): 1299-1301. doi: 10.16766/j.cnki.issn.1674-4152.2016.08.017
[10]	PERNER F, PERNER C, ERNST T, et al. Roles of JAK2 in aging, inflammation, hematopoiesis and malignant transformation[J]. Cells, 2019, 8(8): 854-872. doi: 10.3390/cells8080854
[11]	PASCA S, CHIFOTIDES H T, VERSTOVSEK S, et al. Mutational landscape of blast phase myeloproliferative neoplasms (MPN-BP) and antecedent MPN[J]. Int Rev Cell Mol Biol, 2022, 366: 83-124.
[12]	HAHN A W, LI B, PROUET P, et al. Acute megakaryocytic leukemia: what have we learned[J]. Blood Rev, 2016, 30(1): 49-53. doi: 10.1016/j.blre.2015.07.005
[13]	刘彦权, 殷悦, 陈玉婷, 等. 急性巨核细胞白血病14例临床分析并文献复习[J]. 解放军医学杂志, 2022, 47(10): 1006-1012. https://www.cnki.com.cn/Article/CJFDTOTAL-JFJY202210014.htm LIU Y Q, YIN Y, CHEN Y T, et al. Clinical analysis and literature review of 14 patients with acute megakaryocytic leukemia[J]. Med J Chin PLA, 2022, 47(10): 1006-1012. https://www.cnki.com.cn/Article/CJFDTOTAL-JFJY202210014.htm
[14]	程文文, 路卯, 高艳, 等. 原发性骨髓纤维化转化为急性巨核细胞白血病一例并文献复习[J]. 白血病·淋巴瘤, 2017, 26(8): 491-493. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202403040.htm CHEN W W, LU M, GAO Y, et al. Acute megakaryocytic leukemia transformed from primary myelofibrosis: report of one case and review of literature[J]. Journal of Leukemia & Lymphoma, 2017, 26(8): 491-493. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202403040.htm
[15]	LING T, CRISPINO J D, ZINGARIELLO M, et al. GATA1 insufficiencies in primary myelofibrosis and other hematopoietic disorders: consequences for therapy[J]. Expert Rev Hematol, 2018, 11(3): 169-184. doi: 10.1080/17474086.2018.1436965
[16]	ADACHI Y, YAMAGUCHI Y, SAGOU K, et al. Acute megakaryoblastic leukemia developing as donor cell leukemia after umbilical cord blood transplantation[J]. Intern Med, 2018, 57(4): 569-574. doi: 10.2169/internalmedicine.9005-17
[17]	NGUYEN L X T, TROADEC E, KALVALA A, et al. The Bcl-2 inhibitor venetoclax inhibits Nrf2 antioxidant pathway activation induced by hypomethylating agents in AML[J]. J Cell Physiol, 2019, 234(8): 14040-14049. doi: 10.1002/jcp.28091
[18]	DINARDO C D, PRATZ K, PULLARKAT V, et al. Venetoclax combined with decitabine or azacitidine in treatment-naive, elderly patients with acute myeloid leukemia[J]. Blood, 2019, 133(1): 7-17. doi: 10.1182/blood-2018-08-868752
[19]	DINARDO C D, JONAS B A, PULLARKAT V, et al. Azacitidine and venetoclax in previously untreated acute myeloid leukemia[J]. N Engl J Med, 2020, 383(7): 617-629. doi: 10.1056/NEJMoa2012971
[20]	MEI M, ALDOSS I, MARCUCCI G, et al. Hypomethylating agents in combination with venetoclax for acute myeloid leukemia: update on clinical trial data and practical considerations for use[J]. Am J Hematol, 2019, 94(3): 358-362. doi: 10.1002/ajh.25369
[21]	JIA Y N, LIN D, WANG Z, et al. Diagnostic challenge in mixed phenotype acute leukemia with T/megakaryocyte or T/myeloid lineages accompanied by t(3;3)[J]. Diagn Pathol, 2022, 17(1): 74-80. doi: 10.1186/s13000-022-01257-w
[22]	GAUT D, BURKENROAD A, DUONG T, et al. Venetoclax combination therapy in relapsed/refractory acute myeloid leukemia: a single institution experience[J]. Leuk Res, 2020, 90: 106314-106318. doi: 10.1016/j.leukres.2020.106314
[23]	娄典, 刘利, 秦炜炜. 维奈克拉联合阿扎胞苷治疗老年初治急性髓系白血病的临床分析[J]. 中国肿瘤临床, 2022, 49(15): 775-780. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZL202215004.htm LOU D, LIU L, QIN W W. Clinical analysis of venetoclax combined with azacitidine in elderly patients with newly diagnosed acute myeloid leukemia[J]. Chin J Clin Oncol, 2022, 49(15): 775-780. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZL202215004.htm
[24]	王菲, 孟小莉, 王丛丛, 等. 维奈克拉治疗老年人继发性急性巨核细胞白血病1例并文献复习[J]. 白血病·淋巴瘤, 2022, 31(1): 55-57. WANG F, MENG X L, WANG C C, et al. Venetoclax in treatment of elderly patients with secondary acute megakaryoblastic leukemia: report of 1 case and review of literature[J]. Journal of Leukemia & Lymphoma, 2022, 31(1): 55-57.