Maintenance Treatment With Low-Dose Decitabine After Allogeneic Hematopoietic Cell Transplantation in Patients With Adult Acute Lymphoblastic Leukemia

• Published in: Frontiers in oncology 2021-08, Vol.11, p.710545-710545
• Main Authors: Liu, Jia, Jiang, Zhong-Xing, Xie, Xin-Sheng, Wan, Ding-Ming, Cao, Wei-Jie, Wang, Meng, Liu, Zhen-Zhen, Dong, Zhen-Kun, Wang, Hai-Qiong, Lu, Run-Qing, Zhang, Yin-Yin, Cheng, Qian-Qian, Fan, Ji-Xin, Li, Wei, He, Fei, Guo, Rong
• Format: Article
• Language: English
• Subjects: acute lymphoblastic leukemia; allogeneic hematopoietic stem cell transplantation; decitabine; maintenance; Oncology; prophylaxis; relapse
• ISSN: 2234-943X; 2234-943X
• DOI: 10.3389/fonc.2021.710545

Post-transplant relapse remains a principal leading cause of failure after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with adult acute lymphoblastic leukemia (ALL). The aim of this study was to investigate the efficacy and safety of low-dose decitabine on the prevention of adult ALL relapse after allo-HSCT. In this prospective study, we enrolled 34 patients with ALL who underwent allo-HSCT from August 2016 to April 2020 and received low-dose decitabine maintenance treatment after transplantation. The primary objectives were cumulative incidence of relapse rate (CIR), overall survival (OS), and disease-free survival (DFS). The secondary objectives were graft- -host disease (GVHD) and safety. Among the enrolled 34 patients, 6 patients relapsed and 6 patients died. The 2-year CIR, OS, and DFS were 20.2, 77.5, and 73.6%, respectively. Subgroup analysis revealed the 2-year CIR, OS, and DFS rates of 12 patients with T-ALL/lymphoblastic lymphoma (LBL) were 8.3, 90, and 81.5%, respectively. None of the seven patients with T-ALL relapsed. During maintenance treatment, only one patient (2.9%) developed grade IV acute GVHD and four (11.8%) patients had severe chronic GVHD. Thirty-two patients (94.1%) developed only grade I to II myelosuppression, and two patients (5.8%) developed grade III to IV granulocytopenia. Maintenance treatment with low-dose decitabine after allo-HSCT may be used as a therapeutic option to reduce relapse in patients with adult ALL, especially in patients with T-ALL. Our findings require confirmation in larger-scale controlled trials. Chinese Clinical Trials Registry, identifier ChiCTR1800014888.