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Decitabine Therapy With Priming Regimen Under Study in Poor-Prognosis AML

By: Gavin Calabretta, BS
Posted: Monday, November 8, 2021

Findings from a recent retrospective study published in Hematology suggest that decitabine therapy combined with a priming regimen consisting of aclarubicin, cytarabine, and G-CSF (CAG) may prove effective in treating acute myeloid leukemia (AML) with myelodysplasia-related changes. The study also analyzed the effects of clinical characteristics, gene mutations, karyotype, and allogeneic hematopoietic stem cell transplantation (HSCT) on survival outcomes.

According to study author Binbin Lai, PhD, of Ningbo First Hospital, Zhejiang, China, and colleagues, a meta-analysis of 24 randomized clinical trials showed that decitabine plus CAG treatment in patients with moderate- to high-risk AML and myelodysplasia exhibited better efficacy than single-agent decitabine. “Our findings are consistent with these results, showing that the combined priming regimens could improve the efficacy of decitabine in treating AML,” they commented.

The study enrolled 69 patients with AML, and 49 had myelodysplasia-related changes. Following treatment, 39 patients achieved complete remission (56.5%), and 10 achieved partial remission, for an overall response rate of 71%. A total of 15 patients had no response (21.7%).

As for adverse reactions, five early deaths occurred (7.2%). The authors noted that other events such as bone marrow suppression and infection appeared, but with supportive treatment, they were controllable.

Among clinical characteristics, high white blood cell content and a high proportion of bone marrow blasts appeared to hurt complete and overall remission rates. In contrast, platelet doubling following treatment seemed to have a positive impact. Trial results also showed that individuals with a comutation of three or more myeloid genes had a lower remission rate, whereas TP53 mutations, haplotype, and karyotype seemed to have no significant effect on remission rate. Additionally, allogeneic HSCT demonstrated no significant impact on overall survival or disease-free survival.

Disclosure: The study authors reported no conflicts of interest.

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