地西他滨联合预激方案治疗53例复发难治正常核型急性髓系白血病的疗效分析

OBJECTIVE: To study clinical characteristics of refractory or relapsed DNMT3A(+) cytogenetically normal acute myeloid leukemia (CN-AML) patients, and to explore the overall response rate (ORR) and side effects of these patients followed the therapy including decitabine with CAG or CAG-like regimen. METHODS: In this study we retrospectively analyzed 53 refractory or relapsed CN-AML patients receiving the therapy including decitabine combined with CAG and CAG-like regimen in our center from April 2011 to October 2014. The clinical characteristics and ORR were further analyzed. Based on gene mutations, these patients could be divided into 2 groups: DNMT3A(+) AML patients (n=24) and DNMT3A(−)AML patients (n=29). RESULTS: The median age of DNMT3A(+) AML patients was 46 years old, higher white blood cells and bone marrow blasts were observed in DNMT3A(+) AML group. The ORR and complete response (CR) rate of DNMT3A(+) group were 62.50% and 54.17%, respectively. No differences were observed in ORR and CR rates (P>0.05) between these two groups. DNMT3A(+)/FLT3-ITD(+) CN-AML patients (n=14) had higher ORR and CR rates than DNMT3A(−)/FLT3-ITD(+)CN-AML patients (n=15) (P=0.040 and 0.042, respectively). The one-year overall survival (OS) of DNMT3A(+) AML group and DNMT3A(−)AML group were 59.58%, 54.09%, no differences were observed (P=0.438). 25 patients received further therapy of allo-HSCT, the one-year OS of DNMT3A(+) CN-AML was 87.50% and one-year disease free survival (DFS) was 72.73%, while the one-year OS was 61.54% and one-year DFS was 58.02% in DNMT3A(−)group. No differences were observed between 2 groups (P=0.456, 0.217). CONCLUSION: Decitabine combined with CAG or CAG-like regimen was an effective and safe treatment for refractory or relapsed CN-AML patients. Compared to DNMT3A(−)/FLT3-ITD(+) CN-AML patients, DNMT3A(+)/FLT3-ITD(+) CN-AML patients had higher ORR and CR rates. Decitabine bridged hematopoietic stem cells transplant could likely improve the survival of refractory or relapsed CN-AML patients.