克拉屈滨联合低剂量阿糖胞苷治疗维奈克拉耐药复发难治性急性髓系白血病的疗效及安全性分析-现代医学

克拉屈滨联合低剂量阿糖胞苷治疗维奈克拉耐药复发难治性急性髓系白血病的疗效及安全性分析

单位：中国人民解放军海军第九七一医院血液病科, 山东青岛 266071

分类号：R733.7

出版年·卷·期（页码）：2026·54·第六期（960-967）

摘要：

目的：研究克拉屈滨(CdA)联合低剂量阿糖胞苷(LDAC)治疗维奈克拉(Ven)耐药复发难治性急性髓系白血病(R/R AML)的有效性及安全性。方法：回顾性纳入2022年2月至2025年9月于中国人民解放军海军第九七一医院血液病科接受本方案治疗的10例既往Ven耐药的R/R AML患者，分析其临床特征，评估本方案的有效率、不良事件发生率及患者生存预后。结果：10例患者中位年龄62(24～76)岁，其中Ven难治性患者3例，Ven治疗有效后复发患者7例。1个周期治疗后骨髓原始细胞比例较治疗前显著下降(P=0.017)，总缓解率为60%(6/10)，复合完全缓解率为50%(5/10)，微小残留病变(MRD)阴性率为40%(2/5)。中位随访时间18个月，中位生存期为7.2(95%CI 3.5～10.9)个月，中位无事件生存期为3.5(95%CI 0.5～6.5)个月。所有患者均出现4级中性粒细胞减少、4级血小板减少以及2～3级贫血。感染是最常见的非血液学不良事件，3级以上感染发生率为30%(3/10)。结论：对于Ven耐药的R/R AML患者，CdA联合LDAC方案有效率较高，部分患者可以达到MRD阴性，不良反应可控，治疗过程须重视骨髓抑制及感染并发症的防治。

Objective: To investigate the efficacy and safety of cladribine(CdA) combined with low-dose cytarabine(LDAC) in the treatment of patients with relapsed or refractory acute myeloid leukemia(R/R AML) resistant to venetoclax(Ven). Methods: A total of 10 patients with R/R AML who had previously failed Ven therapy and received this regimen at the Department of Hematology, No. 971 Hospital of the People's Liberation Army Navy, between February 2022 and September 2025 were retrospectively enrolled. Their clinical characteristics were analyzed, and the response rate, incidence of adverse events, and survival outcomes were evaluated. Results: The median age of the 10 patients was 62 years(24-76). Among them, 3 patients had Ven-refractory disease and 7 had relapsed after an initial response to Ven. After one cycle of treatment, the bone marrow blast percentage decreased significantly compared with the pretreatment level(P=0.017). The overall response rate was 60%(6/10), and the composite complete remission rate was 50%(5/10). The minimal residual disease(MRD) negativity rate was 40%(2/5). With a median follow-up of 18 months, the median overall survival was 7.2 months(95%CI 3.5-10.9), and the median event-free survival was 3.5 months(95%CI 0.5-6.5). All patients developed grade 4 neutropenia, grade 4 thrombocytopenia, and grade 2-3 anemia. Infection was the most common non-hematologic adverse event, and the incidence of grade ≥3 infection was 30%(3/10). Conclusion:In patients with R/R AML resistant to Ven, the combination of CdA and LDAC demonstrated a relatively high response rate, with a proportion of patients achieving MRD negativity. The toxicities were manageable; however, close attention must be paid to the prevention and management of myelosuppression and infectious complications.

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