Chatzikalil Elena, Roka Kleoniki, Diamantopoulos Panagiotis T, Rigatou Efthymia, Avgerinou Georgia, Kattamis Antonis, Solomou Elena E
Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece.
"Aghia Sofia" Children's Hospital ERN-PeadCan Center, 11527 Athens, Greece.
J Clin Med. 2024 Apr 1;13(7):2046. doi: 10.3390/jcm13072046.
Over the past two decades, the prognosis in adolescents and young adults (AYAs) diagnosed with acute myeloid leukemia (AML) has significantly improved. The standard intensive cytotoxic treatment approach for AYAs with AML, consisting of induction chemotherapy with anthracycline/cytarabine combination followed by consolidation chemotherapy or stem cell transplantation, has lately been shifting toward novel targeted therapies, mostly in the fields of clinical trials. One of the most recent advances in treating AML is the combination of the B-cell lymphoma 2 (Bcl-2) inhibitor venetoclax with hypomethylating agents, which has been studied in elderly populations and was approved by the Food and Drug Administration (FDA) for patients over 75 years of age or patients excluded from intensive chemotherapy induction schemas due to comorbidities. Regarding the AYA population, venetoclax combination therapy could be a therapeutic option for patients with refractory/relapsed (R/R) AML, although data from real-world studies are currently limited. Venetoclax is frequently used by AYAs diagnosed with advanced hematologic malignancies, mainly acute lymphoblastic leukemia and myelodysplastic syndromes, as a salvage therapeutic option with considerable efficacy and safety. Herein, we aim to summarize the evidence obtained from clinical trials and observational studies on venetoclax use in AYAs with AML. Based on the available evidence, venetoclax is a safe and effective therapeutic option for R/R AML AYA patients. However, further research in larger cohorts is needed to confirm these data, establishing the benefits of a venetoclax-based regimen for this special population.
在过去二十年中,被诊断为急性髓系白血病(AML)的青少年和青年(AYA)患者的预后有了显著改善。对于患有AML的AYA患者,标准的强化细胞毒性治疗方法包括蒽环类药物/阿糖胞苷联合诱导化疗,随后进行巩固化疗或干细胞移植,最近已逐渐转向新型靶向治疗,主要是在临床试验领域。治疗AML的最新进展之一是B细胞淋巴瘤2(Bcl-2)抑制剂维奈克拉与低甲基化药物的联合使用,该联合用药已在老年人群中进行研究,并获得美国食品药品监督管理局(FDA)批准用于75岁以上或因合并症而被排除在强化化疗诱导方案之外的患者。对于AYA人群,维奈克拉联合治疗可能是难治性/复发性(R/R)AML患者的一种治疗选择,尽管目前来自真实世界研究的数据有限。维奈克拉经常被诊断为晚期血液系统恶性肿瘤(主要是急性淋巴细胞白血病和骨髓增生异常综合征)的AYA患者用作具有相当疗效和安全性的挽救治疗选择。在此,我们旨在总结从关于维奈克拉在患有AML的AYA患者中使用的临床试验和观察性研究中获得的证据。基于现有证据,维奈克拉是R/R AML AYA患者的一种安全有效的治疗选择。然而,需要在更大的队列中进行进一步研究以证实这些数据,确立基于维奈克拉的方案对这一特殊人群的益处。