Skip to main content
Home
Zeitschriften
Zeitungen
Podcast
Gesundheitspolitik
Praxis
Allerlei
Jobs
Fachgebiete
Allgemeinmedizin Anästhesiologie & Intensivmedizin Apotheke Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kinder & Jugendheilkunde Neurologie & Psychiatrie Orthopädie & Unfallchirurgie Pflege Urologie Zahnmedizin
Subfächer Innere Medizin
Diabetologie Gastroenterologie Infektiologie Kardiologie Onkologie und Hämatologie Pneumologie Rheumatologie
Fortbildungen
Überblick Fortbildungen DFP-Literaturstudium-Artikel DFP-Webcast Fortbildungen DFP-Podcasts
Erweiterte Suche
Anmelden
nach oben
memo - Magazine of European Medical Oncology

20.11.2023 | original report

Decitabine combined with low-dose cytarabine, aclarubicin and rhG-CSF regimen may be a potential alternative for relapsed/refractory acute myeloid leukemia: A single-center study

verfasst von: Yu Fu, Long Su, Yuying Li, Yehui Tan

Erschienen in: memo - Magazine of European Medical Oncology

Einloggen, um Zugang zu erhalten

Summary

Purpose

To analyze the effectiveness of decitabine combined with low-dose Ara‑C, aclarubicin, and rhG-CSF (DCAG) as a salvage therapy in patients with relapsed/refractory (R/R) acute myeloid leukemia (AML).

Patients and methods

This single-centered retrospective study included patients with relapsed/refractory AML between January 2013 and June 2020. The response rate and survival were calculated, and their correlations with clinical characteristics were estimated.

Results

Thirty-seven patients were enrolled. The overall response rate (ORR) was 56.8% with a complete remission (CR) rate of 51.4%. For patients with non-refractory and refractory AML, the CR rates were 87.5% and 30.4%, respectively (p < 0.001). No remission was found in four primary refractory AML. The incidence of infections was 73%, wherein 13.5% had severe infection, and 2.7% with treatment-related mortality. The median overall survival (OS) and relapse-free survival (RFS) were 10.6 (7.7–13.5) months and 5.0 (2.8–7.2) months, respectively. Patients in the poor risk category had a shorter OS (P = 0.004). The OS and RFS of patients with a recurrence time of < 6 months were shorter (P = 0.018 and P < 0.001, respectively).

Conclusions

The DCAG regimen was an effective and well-tolerated therapeutic alternative for R/R AML, particularly in non-refractory patients. Patients in the poor risk category and early relapse were adverse factors for remission rate and survival.
Literatur
1.
Döhner H, Estey E, Grimwade D, et al. Diagnosis and management of AML in adults:2017 ELN recommendations from an international expert panel. Blood. 2017;129(4):424–47.CrossRefPubMedPubMedCentral
2.
Walter RB, Othus M, Brunett AK, et al. Resistance prediction in AML: analysis of 4601 patients from MRC/NCRI,HOVON/SAKK,SWOG and MD Anderson Cancer Center. Leukemia. 2015;29(2):312–20.CrossRefPubMed
3.
Cui L, Liu Y, Pang Y, et al. Emerging agents and regimens for treatment of relapsed and refractory acute myeloid leukemia. Cancer Gene Ther. 2020;27(1-2):1–14.CrossRef
4.
Ganzel C, Sun Z, Cripe LD, et al. Very poor long-term survival in past and more recent studies for relapsed AML patients: The ECOG-ACRIN experience. Am J Hematol. 2018;93(8):1074–81.CrossRefPubMedPubMedCentral
5.
Kim TK, Gore SD, Zeidan AM. Epigenetic therapy in acute myeloid leukemia: current and future directions. Semin Hematol. 2015;52(3):172–83.CrossRefPubMedPubMedCentral
6.
Negrotto S, Ng KP, Jankowska AM, et al. CpG methylation patterns and decitabine treatment response in acute myeloid leukemia cells and normal hematopoietic precursors. Leukemia. 2012;26(2):244–54.CrossRefPubMed
7.
Jiang X, Wang Z, Ding B, et al. The hypomethylating agent decitabine prior to chemotherapy improves the therapy efficacy in refractory/relapsed acute myeloid leukemia patients. Oncotarget. 2015;6(32):33612–22.CrossRefPubMedPubMedCentral
8.
Song LX, Xu L, Li X, et al. Clinical outcome of treatment with a combined regimen of decitabine and aclacinomycin/cytarabine for patients with refractory acute myeloid leukemia. Ann Hematol. 2012;91(12):1879–86.CrossRefPubMed
9.
Megías-Vericat JE, Martínez-Cuadrón D, Sanz MÁ, et al. Salvage regimens using conventional chemotherapy agents for relapsed/refractory adult AML patients: a systematic literature review. Ann Hematol. 2018;97(7):1115–53.CrossRefPubMed
10.
Tiong IS, Wei AH. New drugs creating challenges in acute myeloid leukemia. Genes Chromosomes. Cancer. 2019;58(12):903–14.
11.
12.
Tawfik B, Sliesoraitis S, Lyerly S, et al. Efficacy of the hypomethylating agents as frontline, salvage, or consolidation therapy in adults with acute myeloid leukemia (AML). Ann Hematol. 2014;93(1):47–55.CrossRefPubMed
13.
Stahl M, DeVeaux M, Montesinos P, et al. Hypomethylating agents in relapsed and refractory AML:outcomes and their predictors in a large international patient cohort. Blood Adv. 2018;2(8):923–32.CrossRefPubMedPubMedCentral
14.
Ritchie EK, Feldman EJ, Christos PJ, et al. Decitabine in patients with newly diagnosed and relapsed acute myeloid leukemia. Leuk Lymphoma. 2013;54(9):2003–7.CrossRefPubMed
15.
Lee SR, Yang DH, Ahn JS, et al. The clinical outcome of FLAG chemotherapy without idarubicin in patients with relapsed or refractory acute myeloid leukemia. J Korean Med Sci.2009;24(3):498–503.
16.
Wang LJ, Ding J, Zhu CY, et al. Clinic outcome of FLAG regimen treating patients with refractory and relapse acute myeloid leukemia. J Exp Hematol. 2016;24(1):19–24.
17.
Martin MG, Welch JS, Augustin K, et al. Cladribine in the treatment of acute myeloid leukemia: a single-institution experience. Clin Lymphoma Myeloma. 2009;9(4):298–301.CrossRefPubMed
18.
Price SL, Lancet JE, George TJ, et al. Salvage chemotherapy regimens for acute myeloid leukemia: is one better efficacy comparison between CLAG and MEC regimens. Leuk Res. 2011;35(3):301–4.CrossRefPubMed
19.
Trifilio SM, Rademaker AW, Newman D, et al. Mitoxantrone and etoposide with or without intermediate dose cytarabine for the treatment of primary induction failure or relapsed acute myeloid leukemia. Leuk Res. 2012;36(4):394–6.CrossRefPubMed
20.
Kohrt HE, Patel S, Ho M, et al. Second-line mitoxantrone, etoposide, and cytarabine for acute myeloid leukemia: a single-center experience. Am J Hematol. 2010;85(11):877–81.CrossRefPubMed
21.
Fan CH, Yu MJ, Mai MY, et al. Efficacy of HAA regimen in the treatment of 64 patients with refractory/relapsed acute myeloid leukemia. Chin J Hematol. 2016;37(2):100–4.
22.
Li L, Zhang X, Yu H, et al. Low-dose hypomethylating agent decitabine in combination with aclacinomycin and cytarabine achieves a better outcome than standard FLAG chemotherapy in refractory/relapsed acute myeloid leukemia patients with poor-risk cytogenetics and mutations. Onco Targets Ther. 2018;11:6863–70.CrossRefPubMedPubMedCentral
23.
Chen Y, Dai M, Liu Q. Efficacy and safety of DAC combined with CAG regimen (decitabine in combined with aclacinomycin, cytarabine and G‑CSF) as a second induction regimen compared with Non-DAC regimen for acute myeloid leukemia who failed the first course of standard induction IA chemotherapy. Blood. 2019;134((sup1):5104–5104.CrossRef
24.
Wang L, Luo J, Chen G, et al. Chidamide, decitabine, cytarabine, aclarubicin, and granulocyte colony-stimulating factor (CDCAG) in patients with relapsed/refractory acute myeloid leukemia: a single-arm, phase 1/2 study. Clin Epigenetics. 2020;12(1):132.CrossRef
25.
Kadia TM, Jain P, Ravandi F, et al. TP53 mutations in newly diagnosed acute myeloid leukemia: Clinicomolecular characteristics, response to therapy, and outcomes. Cancer. 2016;122(22):3484–91.CrossRefPubMed
26.
Hunter AM, Sallman DA. Current status and new treatment approaches in TP53 mutated AML. Best Pract Res Clin Haematol. 2019;32(2):134–44.CrossRefPubMed
27.
Rücker FG, Schlenk RF, Bullinger L, et al. TP53 alterations in acute myeloid leukemia with complex karyotype correlate with specific copy number alterations, monosomal karyotype, and dismal outcome. Blood. 2012;119(9):2114–21.CrossRefPubMed
28.
Hou HA, Chou WC, Kuo YY, et al. TP53 mutations in de novo acute myeloid leukemia patients: longitudinal follow-ups show the mutation is stable during disease evolution. Blood Cancer J. 2015;5(7):e331.CrossRefPubMedPubMedCentral
29.
Welch JS, Petti AA, Miller CA, et al. TP53 and Decitabine in Acute Myeloid Leukemia and Myelodysplastic Syndromes. N Engl J Med. 2016;375(21):2023–36.CrossRefPubMed
Metadaten
Titel
Decitabine combined with low-dose cytarabine, aclarubicin and rhG-CSF regimen may be a potential alternative for relapsed/refractory acute myeloid leukemia: A single-center study
verfasst von
Yu Fu
Long Su
Yuying Li
Yehui Tan
Publikationsdatum
20.11.2023
Verlag
Springer Vienna
Erschienen in
memo - Magazine of European Medical Oncology
Print ISSN: 1865-5041
Elektronische ISSN: 1865-5076
DOI
https://doi.org/10.1007/s12254-023-00933-x