Successful management of acute myeloid leukemia transformed from myelodysplastic syndromes in an elderly patient aged over 80 years old by ultralow dose decitabine combined with amifostine and autologous CIK cells

Abstract

Dear Editor, The myelodysplastic syndromes (MDS) are clonal hematopoietic stem cell diseases that are characterized by cytopenia, dysplasia in one or more of the major myeloid cell lines, and a tendency to transform into acute myeloid leukemia (AML). Approximately, one third of MDS patients will undergo transformation into AML, which is resistant to treatment and ultimately fatal. We describe here a case of MDS in an 85-year-old male patient with transformation AML from MDS who was successfully treated with ultralow dose decitabine, amifostine, and infusion of autologous cytokineinduced killer (CIK) cells (dubbed the DAC regimen). The patient was admitted on March 11, 2010 due to pancytopenia. Past history was unremarkable except hypertension and COPD. His routine blood chemistries were as follows: white blood cell count, 2.9×10/L (neutrophils, 40 %; lymphocytes, 50 %; monocytes, 4.5 %); platelets, 67×10/L; and hemoglobin, 98 g/L. Bone marrow (BM) aspirate revealed 5.2 % blasts and trilineage dysplasia (Fig. 1a). Cytogenetic analysis demonstrated 46, XY[13]/t(7;11)(q35;q14)[10]/ del(4)(p10),t(7;11)(q35;q14)[2]/subdiploid(44)[2]. He was diagnosed with MDS-RAEB-I, IPSS intermediate-2 risk. The patient was given amifostine and erythropoietin, but hemoglobin progressively declined and he became transfusion dependent. BM aspirate on December 17, 2011 revealed 20.2 % blasts and flow cytometry demonstrated transformation AML-M4 (FAB classification) (Fig. 1b). One week later, the patient was started on the DAC regimen. Decitabine (10 mg; Chia-Tai Tianqing Pharmacy Co., Jiangsu, China) was given on d1, 3, 5, 7, and 9. Autologous CIK cells were prepared as previously described [1]. Briefly, on d0, 54 mL venous blood was collected from the median cubital vein of the patient, and peripheral blood mononuclear cells (PBMCs) were isolated by Ficoll-Hypaque density–gradient centrifugation. PBMCs were then washed and cultured in the presence of anti-human CD3 monoclonal antibody, recombinant human interferon-γ, and recombinant human interleukin-2 for 14 days. On d14, 2–6×10 cells were infused. Amifostine (0.4 g) was given on d14–18 and d21–25. The patient received a total of three courses of the regimen. The main side effects included Bo Yang, Hai-tao Wang, Li-li Cai, Yu Zhao, Xiao-hua Chi, Hong-li Zhu, Hai-hong Ran, Yang Yang, Rui-li Yu, Song-wei Li and Xue-chun Lu contributed equally to this work.