Hui Yan, Li Yi, Tong Xiwen, Huang Lifang, Mao Xia, Huang Liang, Zhang Donghua
Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Int J Cancer. 2021 Apr 9. doi: 10.1002/ijc.33595.
Relapsed/refractory acute myeloid leukemia (R/R-AML) is characterized by a high incidence, short survival and poor prognosis. Presently, no unified effective reinduction chemotherapy regimen has been developed. Therefore, the use of reinduction chemotherapy regimens before allogeneic hematopoietic stem cell transplantation (allo-HSCT) is controversial. Our study aims to analyze the prognostic factors of R/R-AML and to evaluate the efficacy of the regimen involved decitabine, cladribine, idarubicin or homoharringtonine, and cytarabine (DCIA/DCHA). Clinical and survival data of 112 R/R-AML patients were obtained. Among the 102 R/R-AML patients that were treated with conventional regimens, we found that poor prognosis was related to a greater proportion of bone marrow blasts (>70%) and not achieving complete remission (non-CR) after the first reinduction chemotherapy. Hematopoietic stem cell transplantation (of which 89.47% was allo-HSCT) following CR after the first reinduction chemotherapy often improves the prognosis. Of the 10 R/R-AML patients that were treated with the DCIA/DCHA regimen, nine patients achieved CR or complete response with incomplete hematopoietic recovery (CRi) after one course of chemotherapy. The median overall survival of the 10 patients was 10.14 (1.23-29.13) months. In conclusion, non-CR was associated with poor prognosis in R/R-AML. Therefore, intensive reinduction chemotherapy should be selected to achieve CR. This creates conditions for allo-HSCT and improves prognosis of R/R-AML patients. The DCIA/DCHA regimen showed good efficacy and tolerable adverse reactions in R/R-AML treatment. This combination may be used as a bridging regimen for allo-HSCT in R/R-AML.
复发/难治性急性髓系白血病（R/R-AML）具有发病率高、生存期短和预后差的特点。目前，尚未制定出统一有效的再诱导化疗方案。因此，在异基因造血干细胞移植（allo-HSCT）前使用再诱导化疗方案存在争议。我们的研究旨在分析R/R-AML的预后因素，并评估包含地西他滨、克拉屈滨、伊达比星或高三尖杉酯碱以及阿糖胞苷（DCIA/DCHA）的方案的疗效。获取了112例R/R-AML患者的临床和生存数据。在102例接受传统方案治疗的R/R-AML患者中，我们发现预后不良与骨髓原始细胞比例较高（>70%）以及首次再诱导化疗后未达到完全缓解（非CR）有关。首次再诱导化疗后达到CR后进行造血干细胞移植（其中89.47%为allo-HSCT）通常可改善预后。在10例接受DCIA/DCHA方案治疗的R/R-AML患者中，9例患者在一个疗程化疗后达到CR或部分血液学恢复的完全缓解（CRi）。这10例患者的中位总生存期为10.14（1.23 - 29.13）个月。总之，非CR与R/R-AML的不良预后相关。因此，应选择强化再诱导化疗以实现CR。这为allo-HSCT创造条件并改善R/R-AML患者的预后。DCIA/DCHA方案在R/R-AML治疗中显示出良好疗效且不良反应可耐受。该联合方案可作为R/R-AML患者allo-HSCT的桥接方案。
