维奈克拉联合阿扎胞苷治疗多发性骨髓瘤继发急性髓系白血病1例并文献复习

陈阳; 魏军安; 冯友繁; 伏媛; 陈巧琳; 张启科; 魏小芳

doi:10.16766/j.cnki.issn.1674-4152.004027

维奈克拉联合阿扎胞苷治疗多发性骨髓瘤继发急性髓系白血病1例并文献复习

doi: 10.16766/j.cnki.issn.1674-4152.004027

1.
甘肃省人民医院血液科，甘肃兰州 730000
2.
兰州市榆中县三角城卫生院，甘肃兰州 730000

基金项目:

甘肃省自然科学基金项目 22JR5RA660

甘肃省人民医院院内青年培育项目 23GSSYF-333

甘肃省卫生健康行业科研项目 GSWSKY2023-78

详细信息

通讯作者:
张启科，E-mail: zqk05@163.com

中图分类号: R733.3 R730.53
计量
- 文章访问数: 5
- HTML全文浏览量: 5
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2024-05-08
- 网络出版日期: 2025-08-14

Venetoclax combined with azacitidine in treatment of acute myeloid leukemia secondary to multiple myeloma: 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多发性骨髓瘤持续缓解状态下继发急性髓系白血病患者的临床资料，并复习相关文献。该例患者为67岁男性，诊断为多发性骨髓瘤(IgA-κ型，DS Ⅲ期，ISS Ⅱ期，R-ISS Ⅰ期)，先后经VRD诱导治疗、自体干细胞移植术后获完全缓解，后来那度胺维持治疗，在持续完全缓解状态下，患者于诊断后的4年4个月继发急性髓系白血病(高危组)，给予维奈克拉联合阿扎胞苷治疗。患者第一疗程后急性髓系白血病形态学完全缓解，微小残留病(minimal residual diease, MRD)阴性，临床症状改善明显。相同治疗共3个疗程后，骨髓细胞形态急性髓系白血病持续缓解，但异常浆细胞比例明显升高，多发性骨髓瘤复发，患者放弃治疗。
- 多发性骨髓瘤 /
- 急性髓系白血病 /
- 维奈克拉 /
- 阿扎胞苷
Abstract: We retrospectively analyzed the clinical data of a patient of acute myeloid leukemia secondary to multiple myeloma treated with venetolclax combined with azacidacidin in Gansu Provincial People's Hospital and reviewed the relevant literature. This patient, a 67-year-old man, was diagnosed multiple myeloma (IgA-κ, DS Ⅲ, ISS Ⅱ, R-ISS Ⅰ), after VRD induction and autologous stem cell transplantation, achieved complete remission and then lenalidomide maintenance therapy. In a state of continuous complete remission, the patient developed acute myeloid leukemia (high-risk group) 4 years and 4 months after diagnosis, then given venetolclax combined with azacidacidin. After the first course of treatment, the patient had complete morphologic remission of acute myeloid leukemia, MRD was negative, and the clinical symptoms improved significantly. After a total of 3 courses of the same treatment, the myeloid morphology of acute myeloid leukemia persisted in remission, but the proportion of abnormal plasma cells increased significantly, multiple myeloma recurred, and the patient abandoned treatment.
- Multiple myeloma /
- Acute myeloid leukemia /
- Venetolclax /
- Azacitidine

HTML全文

图 1 1例多发性骨髓瘤持续缓解状态下继发急性髓系白血病患者骨髓细胞形态学结果(瑞氏染色，×1 000)

Figure 1. Morphological result of bone marrow cells in a patient with acute myeloid leukemia secondary to multiple myeloma(Raysen staining, ×1 000)

下载: 全尺寸图片幻灯片

表 1 1例多发性骨髓瘤持续缓解状态下继发急性髓系白血病患者二代测序

Table 1. NGS in a patient with acute myeloid leukemia secondary to multiple myeloma

变异类型	基因名称	染色体	转录本号	外显子	核苷酸改变	氨基酸改变	变异等位基因频率(%)
可能具有临床意义	TP53	17p13.1	NM_000546.5	6	c.672+1G>A	P.？	57.10
临床意义不确定	CBL	11q23.3	NM_005188.4	2	c.287G>A	p.Arg96His	61.70
	NF1	17q11.2	NM_000267.3	52	c.7741A>G	p.Asn2581Asp	50.90

下载: 导出CSV

参考文献(19)

[1]	MATEOS M V, CAVO M, BLADE J, et al. Overall survival with daratumumab, bortezomib, melphalan, and prednisone in newly diagnosed multiple myeloma (alcyone): a randomised, open label, phase 3 trial[J]. Lancet, 2020, 395(10218): 132-141.
[2]	SAMRA B, RICHARD-CARPENTIER G, KADIA T M, et al. Characteristics and outcomes of patients with therapy-related acute myeloid leukemia with normal karyotype[J]. Blood Cancer J, 2020, 10(5): 47. DOI: 10.1038/s41408-020-0316-3.
[3]	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.
[4]	HOWELL D, SMITH A, APPLETON S, et al. Multiple myeloma: routes to diagnosis, clinical characteristics and survival-findings from a UK population-based study[J]. Brit J Haematol, 2017, 177(1): 67-71.
[5]	LAAKSO M, LAHTINEN R. Acute leukemia and the secondary neoplasms in patients treated with conventional chemotherapy for multiple myeloma: a Finnish Leukaemia Group study[J]. Eur J Haematol, 2000, 65(2): 123-127.
[6]	JIA J, CHEN W M. Characterization and prognostic features of secondary acute myeloid leukemia in survivors of multiple myeloma[J]. Am J Cancer Res, 2023, 13(10): 4803-4810.
[7]	BACCHIARRI F, SAMMARTANO V, SANTONI A, et al. First reported case of secondary mixed phenotype acute leukemia after multiple myeloma[J]. Am J Blood Res, 2021, 11(1): 123-131.
[8]	JONES J R, CAIRNS D A, MENZIES T, et al. Maintenance lenalidomide in newly diagnosed transplant eligible and non-eligible myeloma patients; profiling second primary malignancies in 4 358 patients treated in the myeloma XI trial[J]. EClinical Medicine, 2023, 62: 102099. DOI: 10.1016/j.eclinm.2023.102099.
[9]	SALEEM K, FRANZ J, KLEM M L, et al. Second primary malignancies in patients with haematological cancers treated with lenalidomide: a systematic review and meta-analysis[J]. Lancet Haematol, 2022, 9(12): e906-e918.
[10]	李玲玲, 李梦琳, 张雨, 等. 多发性骨髓瘤患者继发或伴发第二肿瘤的临床特征及预后转归分析[J]. 中国实验血液学杂志, 2023, 31(2): 429-434. LI L L, LI M L, ZHANG Y, et al. Clinical Features and Prognosis of Multiple Myeloma Patients with Secondary Primary Malignancies[J]. Journal of Experimental Hematology, 2023, 31(2): 429-434.
[11]	MUSTO P, ANDERSON K C, ATTAL M, et al. Second primary malignancies in multiple myeloma: an overview and IMWG consensus[J]. Ann Oncol, 2017, 28: 228-245.
[12]	ATTAL M, LAUWERS-CANCES V, MARIT G, et al. Lenalidomide maintenance after stem-cell transplantation for multiple myeloma[J]. N Engl J Med, 2012, 366: 1782-1791.
[13]	ARBER D A, ORAZI A, HASSERJIAN R, et al. The 2016 revision to the world health organization classification of myeloid neoplasms and acute leukemia[J]. Blood, 2016, 127(20): 2391-2405.
[14]	HULEGARDH E, NILSSON C, LAZAREVIC V, et al. Characterization and prognostic features of secondary acute myeloid leukemia in a population-based setting: a report from the Swedish Acute Leukemia Registry[J]. Am J Hematol, 2015, 1: 208-214.
[15]	LI Z, LABOPIN M, CICERI F, et al. Haploidentical transplantation outcomes for secondary acute myeloid leukemia: acute leukemia working party (ALWP) of the European society for blood and marrow transplantation (EBMT) study[J]. Am J Hematol, 2018, 93(6): 769-777.
[16]	OTOUKESH S, SALMAN A, MARCUCCI G, et al. The feasibility of venetoclax and decitabine in therapy-related acute myeloid leukemia with concurrent advanced non-hematological malignancies[J]. Leuk Res, 2019, 84: 106196. DOI: 10.1016/j.leukres.2019.106196.
[17]	魏小芳, 冯友繁, 丁国胜, 等. 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[J]. 中华全科医学, 2024, 22(3): 526-529. doi: 10.16766/j.cnki.issn.1674-4152.003441 WEI X F, FENG Y F, DING G S, et al. Venetoclax combined with azacitidine in treatment of acute megakaryoblastic leukemia transformed from primary myelofibrosis: report of 1 case and review of literature[J]. Chinese Journal of General Practice, 2024, 22(3): 526-529. doi: 10.16766/j.cnki.issn.1674-4152.003441
[18]	孙立, 叶少杰, 周楠, 等. 维奈克拉联合阿扎胞苷治疗不适合标准化疗的新诊断急性髓系白血病疗效分析: 单中心数据[J]. 中华血液学杂志, 2022, 43(10): 826-832. SUN L, YE S J, ZHOU N, et al. Efficacy of venetoclax combined azacitidine in newly diagnosed acute myeloid leukemia unfit for standard chemotherapy: a single center experience[J]. Chinese Journal of Hematology, 2022, 43(10): 826-832.
[19]	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. LOU D, LIU L, QIN W W. Clinical analysis of venetoclax combined with azacitidine in elderly patients with newly diagnosed acute myeloid leukemia[J]. Chinese Journal of Clinical Oncology, 2022, 49(15): 775-780.