Background Relapse is the main cause of death after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in high-risk acute myeloid leukemia (HR-AML). Our center and other 11 HSCT centers in China in the early stage to carry out one clinical research on low-dose Decitabine maintenance treatment to prevent relapse of HR-AML after allo-HSCT. Research has found that maintenance treatment with Decitabine can reduce the relapse rate from 38.3% to 15%.Which HR-AML patients will benefit more for maintenance treatment with Decitabine are worth further exploration in clinical practice.

Methods A retrospective analysis was conducted on 296 patients with HR-AML after allo-HSCT who underwent maintenance treatment with Decitabine for more than 6 courses from February 2019 to June 2022 at our center. The impact of different biological characteristics of HR-AML include age, recurrent genetic abnormalities, mutation gene types, and history of pre-leukemia hematological diseases. The main endpoint of the study is the 2-year relapse rate.

Results Among the 296 patients, 52 were over 60 years old and 244 were under 60 years old, indicating that patients under the age of 60 are more likely to benefit from Decitabine maintenance therapy. Common recurrent genetic abnormalities include: 16 cases of t (8,21), 9 cases of inv (16), 9 cases of t (9,11), 6 cases of inv (3), 30 cases of other abnormalities, and 226 cases of no recurrent genetic abnormalities. After maintenance treatment with Decitabine, the 2-year relapse rate of patients with and without recurrent genetic abnormalities were 12.9% and 20.8%(p=0.043), respectively, indicating that maintenance treatment with Decitabine is effective for patients with recurrent genetic abnormalities. Mutated genes are mainly divided into two categories: methylation related gene mutations (151 cases) and other mutations (145 cases). The 2-year relapse rate of patients with methylation related gene mutations and other mutations were 11.2% and 21.4%, respectively (p=0.012), indicating that maintenance treatment with Decitabine is more effective for patients with methylation related gene mutations. According to the history of pre-leukemia hematological diseases, AML was divided into MDS/MPN transformed AML (54 cases) and primary AML (242 cases). The 2-year relapse rates of the two groups were 14.8% and 17.8% (p=0.12), respectively, and there was no significant difference between the two groups.

Conclusion Maintenance treatment with dexamethasone after high-risk AML transplantation is more effective in patients under 60 years old, recurrent genetic abnormalities, and methylation related gene mutations.

Disclosures

No relevant conflicts of interest to declare.

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2024
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