Reinduction chemotherapy regimen involved decitabine and cladribine improves the prognosis of patients with relapsed or refractory acute myeloid leukemia: A preliminary study

Relapsed/refractory acute myeloid leukemia (R/R‐AML) is characterized by a high incidence, short survival and poor prognosis. Presently, no unified effective reinduction chemotherapy regimen has been developed. Therefore, the use of reinduction chemotherapy regimens before allogeneic hematopoietic stem cell transplantation (allo‐HSCT) is controversial. Our study aims to analyze the prognostic factors of R/R‐AML and to evaluate the efficacy of the regimen involved decitabine, cladribine, idarubicin or homoharringtonine, and cytarabine (DCIA/DCHA). Clinical and survival data of 112 R/R‐AML patients were obtained. Among the 102 R/R‐AML patients that were treated with conventional regimens, we found that poor prognosis was related to a greater proportion of bone marrow blasts (>70%) and not achieving complete remission (non‐CR) after the first reinduction chemotherapy. Hematopoietic stem cell transplantation (of which 89.47% was allo‐HSCT) following CR after the first reinduction chemotherapy often improves the prognosis. Of the 10 R/R‐AML patients that were treated with the DCIA/DCHA regimen, nine patients achieved CR or complete response with incomplete hematopoietic recovery (CRi) after one course of chemotherapy. The median overall survival of the 10 patients was 10.14 (1.23‐29.13) months. In conclusion, non‐CR was associated with poor prognosis in R/R‐AML. Therefore, intensive reinduction chemotherapy should be selected to achieve CR. This creates conditions for allo‐HSCT and improves prognosis of R/R‐AML patients. The DCIA/DCHA regimen showed good efficacy and tolerable adverse reactions in R/R‐AML treatment. This combination may be used as a bridging regimen for allo‐HSCT in R/R‐AML. What's new? About half of younger patients and most older patients with acute myeloid leukemia (AML) experience disease relapse, despite complete remission. Disease that is refractory to primary chemotherapy is likewise frequent. Nonetheless, a unified effective reinduction chemotherapy regimen is lacking for relapsed/refractory AML. This study shows that reinduction chemotherapy using decitabine, cladribine, idarubicin or homoharringtonine, and cytarabine (DCIA/DCHA) leads to complete remission in a majority of patients with relapsed/refractory AML. Additional analyses indicate that allogeneic hematopoietic stem cell transplantation (allo‐HSCT) after complete remission prolongs overall survival. The authors conclude that DCIA/DCHA before allo‐HSCT may be an effective strat