CLAG±DAC regimen in the treatment of refractory/relapsed acute myeloid leukemia
10.3760/cma.j.cn121090-20240604-00203
- VernacularTitle:CLAG±DAC方案治疗难治复发性急性髓系白血病的临床研究
- Author:
Wenxi HUA
1
;
Weiqin YAO
;
Meng ZHOU
;
Jiaqian QI
;
Huizhu KANG
;
Ruju WANG
;
Chengsen CAI
;
Yuejun LIU
;
Depei WU
;
Yue HAN
Author Information
1. 苏州大学附属第一医院，江苏省血液研究所，国家卫生健康委员会血栓及止血重点研究室，国家血液系统疾病临床医学研究中心，苏州 215006
- Keywords:
Leukemia, myeloid, acute;
Relapsed;
Refractory;
Anti-tumor combination chemotherapy regimen;
Decitabine;
FLT3-ITD mutant
- From:
Chinese Journal of Hematology
2024;45(9):838-843
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy and prognosis of CLAG±DAC (Clofarabine, Cytarabine, G-CSF±Decitabine) chemotherapy in patients with relapsed/refractory acute myeloid leukemia (R/R AML) .Methods:Continuous cases of R/R AML treated with the CLAG+DAC protocol or CLAG alone at the First Affiliated Hospital of Soochow University from January 2017 to December 2021 were retrospectively analyzed. The baseline characteristics, individual treatment regimen, treatment effect, disease progression, and survival status of patients were recorded. The factors influencing the efficacy of the CLAG±DAC chemotherapy regimens were analyzed, and the overall survival (OS) time after reinduction was calculated using the Kaplan-Meier method.Results:This study included a total of 53 patients, with 33 male patients and an average age of 40.6 years. Thirty-three patients achieved complete remission (CR+CRi) of the disease after the CLAG±DAC chemotherapy regimen and six patients achieved partial remission (PR), while 14 did not. Thirty-two patients eventually underwent hematopoietic stem cell transplantation, and the median OS of the patients was 55.9 months until follow-up. Patients with disease remission after the application of the CLAG±DAC chemotherapy had a significantly longer survival time than those without remission ( P<0.001). The results of the multifactorial analysis have revealed that combined DAC ( OR=4.60, 95% CI 1.14-23.5, P=0.04) and DNMT3A mutation ( OR=0.14, 95% CI 0.01-0.89, P=0.05) were the factors influencing the efficacy of the CLAG±DAC chemotherapy regimen. The remission rate was relatively higher in patients with R/R AML combined with FLT3-ITD mutation by applying the DAC+CLAG regimen ( OR=10.84, 95% CI 1.48-288.50, P=0.04) . Conclusion:The CLAG±DAC regimen is considered effective in patients with R/R AML, whereas decitabine combined with the CLAG regimen is more suitable for patients with R/R AML combined with FLT3-ITD mutation.
