Efficacy of Low-Dose Decitabine in the Early Relapse of AML/MDS after Allogeneic Hematopoietic Stem Cell Transplantation

Objectives: Retrospective analysis of the efficacy and adverse effects of low-dose Decitabine(DAC) in patients with early relapse of acute myeloid leukemia/myelodysplastic syndrome(AML/MDS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Methods:Fifteen patients with AML/MDS, which were early recurrence after transplantation, received low-dose DAC treatment. The evidence of early recurrence included engraftment index(FISH detection of sex chromosomes, or STR) <95%, MRD (+), fusion gene positive or positive bone marrow blast cells (between 5%~10%). DAC was given (5-10) mg·m²-1·d-1×5 days, every 6∼8 weeks, a maximum for 8 cycles. The treatment outcome, adverse reaction and graft-versus-host disease (GVHD) were analyzed. Fifteen patients included 13 with AML,1 with MDS-RAEB-2, and 1 with chronic myelogenous leukemia (CMML).

Results: The total complete remission (CR) rate was 66.67%(10/15), the Objective response rate (ORR) was 86.67% (13/15); 5 cases of relapse in the effective patients, in which 3 cases with PR was relapse eventually, and 2 CR patients has extramedullary recurrence and bone marrow relapse, respectively, the recurrence rate was 38.46%(5/13). Grade 3 and 4 hepatic dysfunction was 26.67%, Grade 3 and 4 hematological toxicities was 60%.

Conclusion:low-dose of DAC was effective and safe in controlling early recurrence, reducing GVHD symptoms, reducing recurrence rate and prolonging patient survival time.