Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China.
Institute of Hematology, Zhejiang University, Zhejiang, China.
Cancer Med. 2020 Aug;9(15):5327-5334. doi: 10.1002/cam4.3079. Epub 2020 Jun 3.
Adult patients with relapsed or refractory T-cell acute lymphoblastic leukemia (R/R-T-ALL) have extremely poor prognosis, representing an urgent unmet medical need. Finding an optimal salvage regimen to bridge transplantation is a priority. The CAG (cytarabine, aclarubicin, and G-CSF) regimen was initially used by one group in China, showing unexpectedly promising results in 11 R/R-T-ALL patients. Here, we report the multicenter results of 41 patients who received the CAG regimen as salvage therapy. After one cycle of the CAG regimen, complete remission and partial remission were achieved in 33 (80.5%) and two (4.9%) patients, respectively. Failure to respond was observed in six patients (14.6%). Early T-cell precursor (ETP) (n = 26) and non-ETP (n = 15) patients had a similar CR rate (80.8% vs 80.0%, P = .95). Among 41 patients, allo-HSCT was successfully performed in 27 (66%) patients (22 in CR and 5 in non-CR). With a median follow-up time of 12 months, the estimated 2-year overall survival and event-free survival were 68.8% (95% CI, 47.3%-83.0%) and 56.5% (95% CI, 37.1%-71.9%), respectively. The CAG regimen was well-tolerated, and no early death occurred. Our multicenter results show that the CAG regimen is highly effective and safe, representing a novel choice for adult patients with R/R-T-ALL and providing a better bridge to transplantation.
成人复发或难治性 T 细胞急性淋巴细胞白血病（R/R-T-ALL）患者预后极差，代表着一种迫切未满足的医疗需求。寻找最佳的挽救治疗方案以桥接移植是当务之急。中国的一个研究组最初使用 CAG（阿糖胞苷、阿克拉霉素和 G-CSF）方案，在 11 例 R/R-T-ALL 患者中取得了出人意料的良好结果。在此，我们报告了 41 例患者接受 CAG 方案挽救治疗的多中心结果。接受 CAG 方案一个周期后，33 例（80.5%）患者达到完全缓解，2 例（4.9%）患者达到部分缓解，6 例（14.6%）患者治疗失败。早期 T 细胞前体（ETP）（n=26）和非 ETP（n=15）患者的 CR 率相似（80.8% vs 80.0%，P=0.95）。在 41 例患者中，27 例（66%）患者成功进行了异基因造血干细胞移植（allo-HSCT）（22 例在 CR 中，5 例在非 CR 中）。中位随访时间为 12 个月时，估计 2 年总生存率和无事件生存率分别为 68.8%（95%CI，47.3%-83.0%）和 56.5%（95%CI，37.1%-71.9%）。CAG 方案耐受性良好，无早期死亡。我们的多中心结果表明，CAG 方案非常有效且安全，为成人 R/R-T-ALL 患者提供了一种新的选择，并为移植提供了更好的桥接。
