Efficacy and safety of CHG regimen (low-dose cytarabine, homoharringtonine with G-CSF priming) as induction chemotherapy for elderly patients with high-risk MDS or AML transformed from MDS

Abstract

To evaluate the efficacy and toxicity of CHG regimen (low-dose cytarabine, homoharringtonine with G-CSF priming) as an induction chemotherapy for elderly patients with high-risk MDS or acute myeloid leukemia transformed from MDS (MDS-AML). Thirty-three untreated patients (21 high-risk MDS and 12 MDS-AML) were enrolled in this study. Each patient was administered with the CHG regimen comprised of low-dose cytarabine (25mg/day, days 1-14) and homoharringtonine (1mg/day, days 1-14) by intravenous continuous infusion in combination with G-CSF (300μg/day) by subcutaneous injection from day 0 until neutrophil count recovery to 2.0×10(9)/L. The overall response rate (OR) was 66.7% after one course of the CHG regimen with 19 patients reaching CR (57.6%) and 3 patients reaching partial remission (PR) (9.1%). The median overall survival (OS) was 15.0months. Patients with normal serum lactate dehydrogenase (LDH) appeared longer median OS when compared to patients with high LDH level (18months vs. 5months, P=0.011). Grade 3/4 thrombocytopenia occurred in 28% of patients, neutropenia in 34%. No treatment-related deaths occurred during the induction therapy. These data suggest that the CHG priming regimen is effective and safe as a novel induction therapy for elderly patients with high-risk MDS and MDS-AML. The results need to be conformed in further study involving a larger cohort of patients.