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Decitabine combined with minimally myelosuppressive therapy for induction of remission in pediatric high-risk acute myeloid leukemia with chromosome 5q deletion: a report of three cases

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Abstract

Cases of pediatric acute myeloid leukemia (AML) with complex karyotypes including chromosome 5 abnormalities are rare and have a very poor prognosis. Management of AML with monosomy 5/del(5q) has been inconsistent. We treated three adolescents with this AML subtype using combined low-dose cytarabine and mitoxantrone, concurrently with decitabine and G-CSF, for remission induction. Decitabine was also included in the conditioning regimen before hematopoietic cell transplantation (HCT). All three patients achieved complete remission after treatment with this combination therapy. The treatment was well tolerated, and the patients are alive and free of disease at 3.6, 3.2, and 3.0 years after HCT, respectively.

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Data availability statements

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Abbreviations

allo-HSCT allo:

Hematopoietic stem cell transplantation

AML:

Acute myelogenous leukemia

HCT:

Hematopoietic cell transplantation

MDS:

Myelodysplastic syndrome

COG:

Children’s oncology group

OS:

Overall survival

NGS:

Next-generation sequencing

MAG:

Mitoxantrone, cytarabine and G-CSF

CR:

Complete remission

MUD:

Matched unrelated donor

HCT:

Hematopoietic cell transplant

ALL:

Acute lymphoblastic leukemia

HAG:

Homoharringtonine, cytarabine and G-CSF

ATRA:

All-trans-retinoic acid

TACL:

Therapeutic Advances in Childhood Leukemia and Lymphoma

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Acknowledgements

We thank Keith A. Laycock, PhD, ELS, for editing the manuscript.

Funding

This work was partially funded by Jiangsu project (CXTDA2017014, BE2019672), Suzhou project (SS201809, GSWS2020039), and National Clinical Research Center for Hematological Disorders (2020ZKPB02). Raul C. Ribeiro, MD, was partially funded by NCI grant CA21765, by ALSAC, and by the St. Jude Departments of Oncology and Global Pediatric Medicine. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Author notes

  1. Shengqin Cheng, Peifang Xiao, Juxiang Wang, Zhiheng Li, Li Gao, Jiajia Zheng, Yixin Hu and Xin Ding contributed equally to this work.

Authors and Affiliations

  1. Department of Hematology and Oncology, Children’s Hospital of Soochow University, Suzhou Industrial Park, No. 92 Zhongnan Street, Suzhou, 215025, People’s Republic of China

    Shengqin Cheng, Peifang Xiao, Juxiang Wang, Zhiheng Li, Li Gao, Jiajia Zheng, Yixin Hu, Xin Ding, Jing Ling, Qin Lu, Jian Pan, Bohan Li, Jun Lu, Yi Wang & Shaoyan Hu

  2. Department of Hematology and Oncology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China

    Juxiang Wang

  3. Department of Oncology, Division of Leukemia/Lymphoma, and Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Raul C. Ribeiro

Authors
  1. Shengqin Cheng
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  2. Peifang Xiao
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  3. Juxiang Wang
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  4. Zhiheng Li
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  5. Li Gao
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  7. Yixin Hu
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  8. Xin Ding
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  9. Jing Ling
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  10. Qin Lu
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  13. Jun Lu
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  14. Yi Wang
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  15. Raul C. Ribeiro
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  16. Shaoyan Hu
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Contributions

RCR and SH: designed and directed the study, SC: performed all the data analysis, ZL: drafted the manuscript, PX, JW, LG, JZ and YH: responsible for data collection, XD, JL and J: helped with the interpretation of results, YW, JL and QL: helped integrate all the clinical data, BL: helped with the manuscript revising. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Raul C. Ribeiro or Shaoyan Hu.

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Conflict of interest

The authors declare that they have no competing interests.

Ethics statement

The present study was approved by the Ethics Committee of the Children’s Hospital of Soochow University, and the guardians of all of the patients provided written informed consent.

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Cheng, S., Xiao, P., Wang, J. et al. Decitabine combined with minimally myelosuppressive therapy for induction of remission in pediatric high-risk acute myeloid leukemia with chromosome 5q deletion: a report of three cases. Int J Hematol 116, 146–151 (2022). https://doi.org/10.1007/s12185-022-03309-9

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  • DOI: https://doi.org/10.1007/s12185-022-03309-9

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