Abstract
BackgroundPatients with relapsed/refractory acute myeloid leukemia after hematopoietic stem cell transplantation (HSCT) have a poor prognosis, with a 2-year survival rate of 14%. The optimal treatment for these patients remains unclear. To treat these patients, we designed a new salvage regimen consisting of decitabine, cladribine, cytarabine, and granulocyte-stimulating factor (D-CLAG).Case presentationHere, we describe a case of acute monocytic leukemia with a complex karyotype in a 38-year-old female patient who relapsed after her first HSCT, which was performed using a matched sibling donor. The patient did not respond to standard induction chemotherapy and subsequently achieved complete remission with the D-CLAG regimen. No severe hematological or extramedullary toxicity was observed. Subsequently, the patient received a second D-CLAG regimen as a bridge therapy and directly underwent haploidentical related HSCT. Following HSCT, the marrow showed complete hematologic and cytogenetic remission. Currently, 1 year after transplantation, the patient’s general condition remains good.ConclusionsThis case suggests that the D-CLAG regimen can be an option for reinduction in relapsed refractory AML patients as a bridge to transplantation. Nevertheless, further research will be required in the future as this report describes only a single case.
Highlights
Patients with relapsed/refractory acute myeloid leukemia after hematopoietic stem cell transplantation (HSCT) have a poor prognosis, with a 2-year survival rate of 14%
This case suggests that the D-CLAG regimen can be an option for reinduction in relapsed refractory acute myeloid leukemia (AML) patients as a bridge to transplantation
The cladribine, cytarabine, and granulocyte-stimulating factor (CLAG) regimen has been used for the treatment of relapsed/refractory AML either alone or followed by HSCT, resulting in a complete remission (CR) rate of 49–62% [5, 6]
Summary
We chose D-CLAG as a bridge chemotherapy before haploidentical transplantation for a relapsed AML-M5 patient, representing a treatment regimen that has not yet been reported. Our results confirm the high antileukemic efficacy of D-CLAG as a bridge to haploidentical transplantation and that this regimen had acceptable toxicity This case suggests that the D-CLAG regimen could be an option for reinduction in relapsed refractory AML patients as a bridge to transplantation. Because this is a single case report, further research will be required to validate the efficacy of this new regimen
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