Decitabine plus CLAG chemotherapy as a bridge to haploidentical transplantation in the setting of acute myeloid leukemia relapse after HLA-matched sibling transplantation: a case report.

Abstract

BACKGROUND:

Patients with relapsed/refractory acute myeloid leukemia after hematopoietic stem cell transplantation (HSCT) have a poor prognosis, with a 2-year survival rate of 14%. The optimal treatment for these patients remains unclear. To treat these patients, we designed a new salvage regimen consisting of decitabine, cladribine, cytarabine, and granulocyte-stimulating factor (D-CLAG).

CASE PRESENTATION:

Here, we describe a case of acute monocytic leukemia with a complex karyotype in a 38-year-old female patient who relapsed after her first HSCT, which was performed using a matched sibling donor. The patient did not respond to standard induction chemotherapy and subsequently achieved complete remission with the D-CLAG regimen. No severe hematological or extramedullary toxicity was observed. Subsequently, the patient received a second D-CLAG regimen as a bridge therapy and directly underwent haploidentical related HSCT. Following HSCT, the marrow showed complete hematologic and cytogenetic remission. Currently, 1 year after transplantation, the patient's general condition remains good.

CONCLUSIONS:

This case suggests that the D-CLAG regimen can be an option for reinduction in relapsed refractory AML patients as a bridge to transplantation. Nevertheless, further research will be required in the future as this report describes only a single case.

• Authors: Mengqi Jin, Yongxian Hu, Wenjun Wu, Yi Luo, Yamin Tan, Jian Yu, Aiyun Jin, Luxin Yang, He Huang, Guoqing Wei
• Journal: BMC cancer (BMC Cancer) Vol. 19 Issue 1 Pg. 242 (Mar 18 2019) ISSN: 1471-2407 [Electronic] England
• PMID: 30885156 (Publication Type: Case Reports, Journal Article)

Chemical References

• HLA Antigens
• Cytarabine
• Granulocyte Colony-Stimulating Factor
• Cladribine
• Decitabine

Topics

• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Cladribine (therapeutic use)
• Cytarabine (therapeutic use)
• Decitabine (therapeutic use)
• Female
• Granulocyte Colony-Stimulating Factor (therapeutic use)
• HLA Antigens (immunology)
• Hematopoietic Stem Cell Transplantation (methods)
• Histocompatibility Testing
• Humans
• Leukemia, Myeloid, Acute (therapy)
• Neoplasm Recurrence, Local (therapy)
• Remission Induction (methods)
• Salvage Therapy (methods)
• Siblings
• Transplantation, Haploidentical (methods)
• Treatment Outcome