Improved outcome of children with relapsed/refractory acute myeloid leukemia by addition of cladribine to re‐induction chemotherapy

Abstract

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Decitabine as epigenetic priming with CLAG induce improved outcome of relapsed or refractory acute myeloid leukemia in children

“…In this study, we administered DAC as HMA priming of the CLAG salvage regimen, which exhibited significant anti-leukemia activity in AML with a CR/CRi rate of 70.6% compared to 63.6% for the CLAG regimen. The CLAG ± DAC regimen showed a significantly higher CR rate than the conventional regimen (22–23%) in children [ 1 , 2 ]. There are no data on the CR rate for DAC combined with cladribine-based regimens in children.…”

“…The outcome of R/R AML remains poor. We reported a total 3-year OS of 63.4% and EFS of 53.5% in cladribine-based regimens, which was higher than traditional induction with a 3-year OS of 22.2–40.4% and EFS of 22.2–34.9% [ 1 , 2 ]. Univariate analysis revealed that poor prognosis was related to poor cytogenetics, failure to achieve CR, and not undergoing SCT in our report.…”

“…The outcome of relapsed or refractory (R/R) acute myeloid leukemia (AML) in children remains poor, and the optimal salvage regimen is uncertain. Conventional chemotherapy with anthracycline- and cytarabine-based regimens are disappointing with complete remission (CR) of 22–23% in children [ 1 , 2 ]. There is currently no standard reinduction or salvage chemotherapy for R/R AML, and many trials are focused on adding targeted therapies to AML regimens.…”

“…According to reported studies, the addition of medications with different mechanisms to CLAG can increase the efficacy for R/R AML. CLAG regimens plus “X” includes mitoxantrone (M) [ 2 , 6 ], pegylated liposomal doxorubicin [ 7 ], or aclacinomycin [ 8 ], most of which are cytotoxic agents. The CR rates due to the above regimens range from 49 to 75%, which is comparable to the CLAG regimen.…”

Analysis of efficacy, safety and prognostic factors of DAC‑HAA treatment in Chinese pediatric patients with refractory or relapsed acute myeloid leukemia

“…The CR rate with FLAG-Ida is 52.1% ( 16 ). MEC is also occasionally used as the primary regimen in patients with R/R-AML, with CR rates of 18-66% ( 17 ).…”