Experience of DCAG regime in patients with refractory or relapsed acute myeloid leukemia

Abstract

Objective To analyze efficacy and safety of DCAG(decitabine+ cytarabine+ aclacinomycin+ granulocyte colony stimulating factor) regime in patients with refractory or relapsed acute myeloid leukemia (AML). Methods Clinical data form patients with refractory or relapsed AML who were treated with one course of DCAG from November 2016 to May 2018 in Henan Provincial People’s Hospital were reviewed. Results Thirty patients including 20 males(66.7%) and 10 females(33.3%), with refractory or relapsed AML were garthed with a median age of 52 (18 to 73) years. Of 18 cases (60%) in refractory group and 12 cases (40%) in relapsed group, the median previous chemotherapy courses were 6(2 to 8) and 4(1 to 12). After one course of DCAG chemotherapy, patients were reexamined by bone marrow image. The examination results showed that 21 patients(70.0%) achieved complete remission(CR), no patient (0.0%) received partial remission (PR) and 9 patients (30.0%) received non remission (NR). The overall response rate (ORR) was 70.0%, with 61.1%(11/18)in refractory group and 83.3%(10/12)in relapsed group respectively. Twenty-eight patients (93.3%) had grade 4 neutropenia and thrombocytopenia. All patients had fever during neutropenia, with 17 cases (56.7%) pulmonary infection, 4 cases (13.3%) perianal infection, 1 case (3.3%) skin soft tissue infection and 1 case(3.3%) oral infection. Twenty-five patients (83.3%) had gastrointestinal reactions such as nausea and vomiting during chemotherapy. Liver and kidney dysfunction occurred in 4 patients (13.3%). For the thirty patients, the median event free survival (EFS) and overall survival (OS) were 124(14 to 462) d and 212(38 to 537) d respectively. Up to now, 12 patinents (36.4%) still survived, 6 patient(53.3%) died and 2 patients (6.7%)were lost to follow up. The median EFS and OS in CR patients were significantly longer than those in NR, that is EFS: 217(40 to 462 vs. 14(14 to 14) d, OS: 236(86 to 537)d vs. 67(38 to 161)d, (P<0.01). Conclusions DCAG regimen has a definite effect on refractory and relapsed AML. The CR rate of relapsed AML patients is higher than that of refractory AML patients, but there is no significant difference between the two groups. The EFS and OS of CR patients are longer than those of NR patients, and there is a significant difference between the two groups. Hematological support therapy and infection control are the keys to success. Key words: Acute myeloid leukemia; Recurrence and refractory; DCAG regimen; Therapeutic effect; Adverse reactions; Prognosis