Clinical Observation On Decitabine And Chidamide Combined With HA Regimen In Consolidation Treatment Of Acute Myeloid Leukemia Patients With T(8;21)

Objective:To analyze the clinical efficacy and safety of decitabine and chidamide combined with HA regimen(DCHA regimen)in consolidation treatment of acute myeloid leukemia patients with t(8;21),and to explore the relationship between dynamic change of MRD and relapse.Methods:The clinical data of 26 AML patients with t(8;21)(14-64 years old)admitted to the first hospital in handan city between February 2016 to June 2019 were analyzed retrospectively.The 26 patients reached complete remission after 1-2 courses of induction therapy and were divided into DCHA group(n=10)and HD-Ara-C group(n=16)according to post-remission treatment methods.The patients in the DCHA group were treated with DCHA regimen(4 courses),while those in the HD-Ara-C group were treated with high-dose cytarabine(4courses).The long-term prognosis including Relapse-free survival(RFS),Overall survival(OS)and incidence of adverse reactions were compared among the two groups,and the relationship between dynamic change of MRD and relapse was discussed.MRD is achieved by monitoring of AML1-ETO fusion gene expression level.Results:1.The 2-year RFS rate of the DCHA group and the HD-Ara-C group was75%and 35%respectively,with statistically significant difference(P<0.05).The2-year OS rate of the DCHA group and the HD-Ara-C group was 73%and 40%respectively,with statistically significant difference(P<0.05).2.The median duration of PLT<20×10~9was 14.5 days in the DCHA group and5 days in the HD-Ara-C group,with statistically significant difference(P<0.05).The median duration of agranulocytosis was 12.5 days in the DCHA group and 7 days in the HD-Ara-C group,with statistically significant difference(P<0.05).The incidence of infection of the DCHA group and the HD-Ara-C group was 70%and 46.9%respectively,with statistically significant difference(P﹤0.05).There was no statistically significant difference in the incidence of nausea and vomiting,and liver function damage in the two groups(P﹥0.05).3.In the DCHA group,after the first consolidation treatment,the recurrence rate of≥3log group(AML1-ETO transcription decreased≥3log compared with the level at diagnosis)was 0%,while that of<3log group(AML1-ETO transcription decreased<3log compared with the level at diagnosis)was 100%,there was significant difference between the two groups(P<0.05).In the DCHA group,after the second consolidation treatment,the recurrence rate of≥3log group was 11.1%,while that of<3log group was 100%,there was no significant difference between the two groups(P>0.05).4.In the HD-Ara-C group,after the first consolidation treatment,the recurrence rate of≥3log group(AML1-ETO transcription decreased≥3log compared with the level at diagnosis)was 25%,while that of<3log group(AML1-ETO transcription decreased<3log compared with the level at diagnosis)was 91.7%,there was significant difference between the two groups(P<0.05).In the HD-Ara-C group,after the second consolidation treatment,the recurrence rate of≥3log group was 66.7%,while that of<3log group was 85.7%,there was no significant difference between the two groups(P>0.05).Conclusions:1.DCHA consolidation treatment can improve the long-term survival efficacy of patients with t(8;21)AML.2.DCHA consolidation treatment can prolong the period of myelosuppression and increase the risk of infection.3.Patients in<3log group(AML1-ETO transcription decreased<3log compared with the level at diagnosis)had a higher risk of recurrence than those in≥3log group(AML1-ETO transcription decreased≥3log compared with the level at diagnosis)after the first consolidation treatment.