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.