Acute myeloid leukemia patients with high-risk karyotypes benefit from decitabine in combination with modified CAG

Abstract

Abstract This study aims to investigate the cytogenetic and molecular characteristics of patients with Acute Myeloid Leukemia (AML) and determine which patients would benefit most from a low-intensity regimen of decitabine in combination with modified CAG (D-CAG) or intensive chemotherapy. We retrospectively analyzed cytogenetic and molecular data from 331 newly diagnosed AML patients and investigated the relationship between genetic characteristics, risk status, treatments and clinical outcomes. The median followed-up was 45 months (2-120 months). Overall, a single cycle of IA induction resulted in a CR rate of 79.3%, which was superior to the 66.4% observed in the cohort treated with D-CAG (P < .05). However, there was no significant difference in ORR between the two arms. The median OS was reduced in the D-CAG cohort compared to the IA cohort (P < .05). Favorable-risk groups and patients who undergo allo-HSCT treated with IA had longer OS than those in the D-CAG groups (P < .05). While the median OS of the intermediate- and high-risk groups who were not recipients of allo-HSCT was comparable between two regimen. Within the IA group, patients with TET2, NRAS, and biallelic CEBPA gene mutations achieved better OS than those in the D-CAG group (P < .05). While older patients with complex and monosomal karyotypes were tend to have longer median OS compared to younger patients (P < .05). In conclusion, it is crucial to select AML chemotherapy regimens based on karyotypes and genetic characteristics. D-CAG may be a better choice for AML patients with high-risk karyotypes.