Research Paper Volume 12, Issue 7 pp 5792—5811

Decitabine in combination with low-dose cytarabine, aclarubicin and G-CSF tends to improve prognosis in elderly patients with high-risk AML

Ming Hong1,2,3, , Han Zhu1,2,3, , Qian Sun1,2,3, , Yu Zhu1,2,3, , Yi Miao1,2,3, , Hui Yang1,2,3, , Hai-Rong Qiu1,2,3, , Jian-Yong Li1,2,3, , Si-Xuan Qian1,2,3, ,

  • 1 Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, Jiangsu Province, China
  • 2 Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
  • 3 The Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, Jiangsu Province, China

Received: October 27, 2019       Accepted: March 19, 2020       Published: April 1, 2020
How to Cite

Copyright © 2020 Hong et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


We evaluated the risk status and survival outcomes of 125 elderly acute myeloid leukemia (AML) patients treated with decitabine in combination with low-dose cytarabine, aclarubicin, and G-CSF (D-CAG). The risk status was evaluated by determining the frequency of recurring gene mutations using next-generation sequencing (NGS) analysis of 23 selected genes and cytogenetic profiling of bone marrow samples at diagnosis. After a median follow-up of 12 months (range: 2-82 months), 86 patients (68.8%) had achieved complete remission after one cycle of induction, and 94 patients (75.2%) had achieved it after two cycles. The median overall survival (OS) and disease-free survival (DFS) were 16 and 12 months, respectively. In 21 AML patients aged above 75 years, the median OS and DFS were longer in the low- and intermediate-risk group than the high-risk group, but the differences were not statistically significant. The median OS and DFS were similar in patients with or without TET2, DNMT3A, IDH2, TP53 and FLT3 mutations. Multivariate analysis showed that patient age above 75 years, high-risk status, and genetic anomalies, like deletions in chromosomes 5 and/or 7, were significant variables in predicting OS. D-CAG regimen tends to improve the prognosis of a subgroup of elderly patients with high-risk AML.


AML: Acute myeloid leukemia; PS: Performance status; CR: Complete remission; OS: Overall survival; DFS: Disease-free survival; ORR: Objective response rate; NGS: Next-generation sequencing; ECOG: Eastern Cooperative Oncology Group; BM: Bone marrow; TGS: Targeted gene sequencing; PR: Partial remission; NR: No remission; NCI: National Cancer Institute; AML-RCA: AML with recurrent cytogenetic abnormalities; AML-MRC: AML with myelodysplasia-related changes; t-AML: Therapy-related AML; AML NOS: AML not otherwise specified; WBC: White blood cell count; WHO: World Health Organization.