Chidamide plus DCAG regimen in treatment of pediatric acute myeloid leukemia: A report of three cases and literature review

  Background  Childhood acute myeloid leukemia has high recurrence rate, multiple drug resistance, and the side effects of traditional chemotherapy are serious. In recent years, with the development of epigenetic research, chidamide has become a research hotspot. There are a few reports at home and abroad about the application of CDCAG regimen (citabine, decitabine, cytarabine, clarithromycin and granulocyte stimulating factor) in the treatment of adult AML, which has a good curative effect and low complications. However, there is no report about the large-scale application of CDCAG regimen in children.

  Objective  To investigate the safety and efficacy of chidamide, decitabine, cytarabine, aclarubicin and PEG-rhG-CSF (CDCG) regimen on acute myeloid leukemia (AML) in children with infection.

  Methods  Three cases of AML with infection were treated with CDCG regimen. Case 1 was a 10-year-old girl, who was admitted on October 23, 2020. She developed pulmonary infection after one course of chemotherapy with DAE regimen, and then received two courses of chemotherapy with CDCG regimen. Case 2 was a 12-year-old girl, who was admitted on October 21, 2020. She developed recurrent fever and cough, and had pulmonary infection at the time of admission. After the first course of chemotherapy with DAE regimen, the pulmonary infection aggravated and abdominal infection occurred. The second course of chemotherapy was replaced with CDCG regimen. Case 3 was a 12-year-old girl, who was admitted on February 18, 2021. She developed sinusitis and left mastoiditis, and received a course of CDCG chemotherapy.

  Results  After 1-3 courses of CDCG regimen, bone marrow morphology and molecular biology results showed complete remission. Grade 3/4 adverse events were infection and neutropenia with fever. No other adverse event was found.

  Conclusion  The application of CDCG regimen in the treatment of childhood AML with infection can achieve CR, and the incidence of adverse events is lower than that of other regimens. A total of 108 cases with CDCAG regimen are collected by literature search, and 48.15% of them receive CR/CRi after 1-2 courses of CDCAG regimen, which suggests that this regimen is an effective method for the treatment of AML in children with infection.