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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

Authors Li L, Zhang X, Yu H, Zhang M, Xu M, Liu J, Fu Y, Meng H, Lyu C, Li X, Zhou J

Received 8 January 2018

Accepted for publication 24 July 2018

Published 12 October 2018 Volume 2018:11 Pages 6863—6870


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Andrew Yee

Peer reviewer comments 2

Editor who approved publication: Dr Yao Dai

Limin Li,* Xiaoqian Zhang,* Hongjuan Yu, Mingwen Zhang, Mengyuan Xu, Jie Liu, Yueyue Fu, Hongbin Meng, Chengfang Lyu, Xiaoxia Li, Jin Zhou

Department of Hematology, Institute of Hematology and Oncology of Heilongjiang Province, Hematology and Oncology Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China

*These authors contributed equally to this work

Background: Relapsed and refractory acute myeloid leukemia (RR-AML) still poses major treatment concerns. Current treatments include high doses of cytarabine or fludarabine in combination with cytarabine and G-CSF (FLAG), but provide mixed results. Low-dose decitabine, a hypomethylating drug, in combination with aclarubicin and cytarabine (DAC) has shown safety and efficacy in the treatment of AML; however, clinical data are limited for the treatment of RR-AML.
Methods: In this study, we retrospectively compared the response and safety of DAC vs FLAG for RR-AML patients.
Results: For the 35 patients with RR-AML enrolled in this study, the overall response rates reached 100% and 55.6% in the DAC group and FLAG group, respectively (P=0.002). Complete response rates after DAC and FLAG treatment were 64.7% and 33.3%, respectively (P=0.002). Median overall survival (95% CI) of the DAC treatment group was significantly higher than for the FLAG group (median not achieved vs 16.8 months, P=0.021).
Conclusion: DAC treatment was also more effective in those patients with poor prognosis, suggesting that DAC resulted in a better outcome for RR-AML treatment. In conclusion, in our study, DAC therapy provided more safety and effectiveness and lower toxicity in the treatment of RR-AML compared to FLAG therapy.

Keywords: AML, refractory diseases, relapsed diseases, decitabine, chemotherapy

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