老年AML治疗--陆益龙.pptxVIP

老年急性髓系白血病的治疗;老年AML的流行病学;2011年美国数据;;老年急性白血病特点;Klepin HD. J Clin Oncol. 2014, 32:1;Klepin HD. J Clin Oncol. 2014, 32:1; 良好、中等或不良生物学指标;造血细胞移植合并症指数（HCT-CI）评分;NCCN(2017)关于年龄?60岁AML患者的诱导治疗建议; (2)预后不良细胞遗传学/分子标志/前驱血液病史/治疗相关性AML (A)临床试验； (B)更低强度治疗(5-azacytidine，decitabine) (C)标准剂量AraC(100-200mg/m2/dx7d)+IDA 12mg/m2 (优先)或DNR 60-90mg/m2/dx3d或MTZ(12mg/m2/dx3d)的方案； (D)氯法拉滨±标准???量AraC (III类推荐，2017年);NCCN(2017)关于年龄?60岁AML患者的缓解后治疗建议;NCCN Guidelines Version 1.2018 Acute Myeloid Leukemia;NCCN Guidelines Version 1.2019 Acute Myeloid Leukemia;Decitabine 10天方案治疗AML(初诊)-MDACC; 共入组53例初诊AML患者，CR率47%(总有效率64%)，达CR的中位疗程数为3疗程。治疗30天内死亡率2%，8周内的死亡率15%。中位OS 55周，DFS46周。;Decitabine 10天方案治疗效果;Decitabine 10天方案治疗效果;Decitabine 10天方案治疗不良事件 ; ten-day decitabine (20 mg/m2/d, 4W repeat); low-dose cytarabine:LDAC;(N Engl J Med. 2016 Nov 24; 375(21): 2023–2036. );(N Engl J Med. 2016 Nov 24; 375(21): 2023–2036. );Decitabine在TP53 阳性的AML和MDS患者治疗效果;Panels B and C show mutation clearance observed in 2 patients with TP53 mutations. Panel D shows the rate of clearance of 21 TP53 mutations identified in 16 patients. Panel E shows the rate of clearance of mutations (specifically, in genes that were mutated in at least 5 of the 54 patients with samples that could be evaluated) ;AML低剂量化疗与靶向药物治疗的选择;Epigenetic Therapy in the Clinic;Targeting acute myeloid leukemia with TP53-independent vosaroxinFuture Oncol. 2017 Jan; 13(2): 125–133; MRC: Medical Research Council; NCCN: National Comprehensive Cancer Network; PS: Performance status; sc.: Subcutaneously;TP53+AML靶向治疗----VOSAROXIN结论;venetoclax in combination therapy for relapsed and refractory acute myeloid leukemia. Am J Hematol. 2018;93:401–407.;venetoclax combination drugs;Documented infectious and cytopenia-related adverseevents;venetoclax治疗结果;venetoclax治疗结果;A, All patients (n 5 43). B, Patients achieving CR/CRi (n 5 5).C, Patients achieving ORR (i.e., CR/CRi/PR/MLFS) (n 5 9);venetoclax治疗结论;对venetoclax有反应的基因表形;Venetoclax