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Re-induction with modified CLAG regimen in relapsed or refractory acute myeloid leukemia in children bridging to allogeneic hematopoietic stem cell transplantation

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Abstract

Background

The prognosis for relapsed or refractory acute myeloid leukemia (RR-AML) in children is poor, and the preferred salvage chemotherapy is unclear. One regimen is cladribine, cytarabine, and granulocyte-colony stimulating factor (CLAG), but little is known about its efficacy and safety in children with RR-AML.

Methods

We enrolled RR-AML patients aged 0–18 years who received modified CLAG regimen for re-induction between July 1, 2015 and April 1, 2018, or conventional induction between August 1, 2011 and April 1, 2018. Patients were followed up to March 31, 2019. Patients underwent allogeneic stem cell transplantation (allo-SCT) or chemotherapy after the induction of complete remission (CR). The CR rate, survival, and side effects were analyzed.

Results

The CR rate for induction was 66.7% after one cycle and 75.0% after two cycles of the CLAG regimen in 12 children. The nine children who received conventional chemotherapy had a CR rate of 22.2% after one cycle and 33.3% after two cycles (P = 0.087 vs. CLAG). The 3-year event-free survival (EFS) of the CLAG group and the conventional treatment group were 44.4 ± 15.7% and 22.2 ± 13.8% (P = 0.112). The 3-year overall survival of the two groups were 59.5 ± 16.2% and 22.2% ± 13.8% (P = 0.057). The 3-year EFS for allo-SCT and chemotherapy after CLAG regimen was 66.7 ± 19.2% and 25.0 ± 21.7% (P = 0.015). A single case of chemotherapy-related death was recorded.

Conclusion

Our data suggest a promising CR rate using CLAG salvage treatment in childhood RR-AML. Allo-SCT after CR may improve the long-term outcome in these patients.

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Funding

This study was supported by a grant from Shanghai Science and Technology Committee Projects No. 14411950602 and No. 18ZR1431200.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, No. 24, lane 1400, West Beijing Road, Shanghai 200040, China

    Na Zhang, Jing-Bo Shao, Hong Li, Jing-Wei Yang, Kai Chen, Jia-Shi Zhu & Hui Jiang

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  1. Na Zhang
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  3. Hong Li
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  7. Hui Jiang
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Contributions

ZN was responsible for the design of the study, wrote the first draft, and reviewed the final version. JH was the guarantor and revised the whole paper critically for important intellectual content. SJB reviewed and revised the manuscript. LH and YJW collected the patients’ data. ZJS and CK completed the statistical analysis and interpreted the data. All the authors contributed to the design and approved the final version to be published.

Corresponding author

Correspondence to Hui Jiang.

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Ethical approval

The study was approved by the Ethics Committee of Shanghai Children’s Hospital (No. 2015035).

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None declared.

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Zhang, N., Shao, JB., Li, H. et al. Re-induction with modified CLAG regimen in relapsed or refractory acute myeloid leukemia in children bridging to allogeneic hematopoietic stem cell transplantation. World J Pediatr 16, 152–158 (2020). https://doi.org/10.1007/s12519-019-00321-8

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