维奈克拉（Venetoclax）联合阿扎胞苷和西达本胺治疗难治复发急性髓系白血病6例报告并文献复习

目的 探讨维奈克拉（Venetoclax）联合阿扎胞苷和西达本胺方案治疗难治复发急性髓系白血病（refractory/relapsed acute myeloid leukemia，R/R AML）患者的临床疗效和安全性。方法 回顾性分析2021年3月15日至2021年11月30日于北京大学人民医院血液科采用Venetoclax联合阿扎胞苷和西达本胺方案治疗的6例R/R AML患者的疗效及安全性，同时监测并统计患者在诱导期间不同时间点（第7天、第14天、第21天和第28天）的Venetoclax稳态谷浓度（Cmin）。 结果 6例R/R AML患者中，3例观察到临床反应，其中完全缓解（complete remission，CR）2例，CR伴血液学不完全恢复（CR with incomplete hematological recovery，CRi）1 例。中位随访时间为178 d，5例患者存活，总生存率为83.3%（5/6）。6例患者诱导第7天、第14天、第21天和第28天的Venetoclax稳态Cmin分别为（3 181.67±1 631.90） ng/mL，（2 688.67±1 926.36） ng/mL，（2 142.17±1 380.35） ng/mL，（2 766.67±1 138.55） ng/mL。结论 Venetoclax联合阿扎胞苷和西达本胺方案可提高R/R AML患者的疗效，有望成为该类患者挽救性治疗的可行选择之一。

Combination of Venetoclax,Azacitidine and Chidamide in treating refractory and relapsed acute myeloid leukemia: six cases reports and literature review

Objective To investigate the clinical efficacy and safety of Venetoclax combined with Azacitidine and Chidamide in treating the patients with refractory and relapsed acute myeloid leukemia (R/R AML). Methods The efficacy and safety of Venetoclax combined with Azacitidine and Chidamide for 6 R/R AML patients treated in the Department of Hematology, Peking University People's Hospital, from March 15, 2021 to November 30, 2021, were retrospectively analyzed. The steady-state trough concentrations (Cmin) of Venetoclax at different times during the induction period (day 7, 14, 21 and 28) were monitored and counted. Results Among the 6 R/R AML patients, 3 patients showed clinical response, including 2 complete remission (CR) and 1 CR with incomplete hematological recovery (CRi). The median follow-up time was 178 days. There were 5 patients currently alive, with an overall survival (OS) rate of 83.3%(5/6). The steady-state Cmin of Venetoclax on day 7, 14, 21 and 28 were (3 181.67±1 631.90) ng/mL, (2 688.67±1 926.36) ng/mL, (2 142.17±1 380.35) ng/mL, (2 766.67±1 138.55) ng/mL, respectively. Conclusions Venetoclax combined with Azacitidine and Chidamide can improve the clinical efficacy in R/R AML patients, and such a combination is expected to be one of the feasible options for the salvage therapy of R/R AML patients.