Abstract: Objective To study the effects of venetoclax or CAG combined with azacitidine on patients with recurrent refractory acute myeloid leukemia（AML）. Methods The clinical data of 65 patients with recurrent refractory AML in the hospital between July 2019 and December 2020 were retrospectively analyzed,and the patients were divided into venetoclax group （n=30,venetoclax + azacitidine） and CAG group（n=35,CAG + azacitidine） according to different treatment regimens. The efficacy was compared between the two groups after 4 weeks of treatment,prognosis indicator （WT1）,quality of life [Karnofsky Performance Status （KPS）],levels of tumor necrosis factor-α（TNF-α） and interferon γ（IFN-γ） and incidence rates of adverse reactions were compared between the two groups after 4 weeks, 12 weeks and 24 weeks of treatment. The follow-up results of the two groups were compared. Results After 4 weeks of treatment,the ORR of venetoclax group was higher than that of CAG group（P<0.05）. After 4,12 and 24 weeks of treatment,the WT1 expression level in both groups was decreased,and the expression level of venetoclax group was lower than that of CAG group. The levels of TNF-α and IFN-γ were increased in the two groups, and the levels were higher in venetoclax group than those in CAG group（P<0.05）. The incidence rates of Ⅲ~Ⅳ degree bone marrow suppression, nausea and vomiting and abnormal liver-kidney function were lower in venetoclax group than those in CAG group while the incidence rates of diarrhea and musculoskeletal pain were higher than those in CAG group （P<0.05）. After 24 weeks of treatment,KPS score in venetoclax group was higher than that in CAG group （P<0.05）. The median follow-up time was 7 months （1~15 months）. By the end point of follow-up,the overall survival （OS） rate of venetoclax group was 53.33% （16/30）and that of CAG group was 42.86% （15/35）,and there was no statistical significance in OS rate between the two groups（P>0.05）. The leukemia-free survival （LFS） rate of 33.33% in venetoclax group was significantly higher than 11.43% in CAG group（P<0.05）. Conclusion Venetoclax + azacitidine has a better efficacy than CAG + azacitidine in the treatment of recurrent refractory AML,and the former one can improve the body's inflammation and has better prognosis, higher quality of life and lower incidence rates of bone marrow suppression, nausea and vomiting and abnormal liver-kidney function, but has higher incidence rates of diarrhea and musculoskeletal pain.

Key words: Venetoclax, Azacitidine, CAG, regimen, Acute, myeloid, leukemia, Prognosis