The efficacy and toxicity of the CHG priming regimen (low-dose cytarabine, homoharringtonine, and G-CSF) in higher risk MDS patients relapsed or refractory to decitabine

J Cancer Res Clin Oncol. 2019 Dec;145(12):3089-3097. doi: 10.1007/s00432-019-03031-w. Epub 2019 Sep 26.

Abstract

Purpose: Myelodysplastic syndromes (MDSs) refractory or relapsed after hypomethylating agents (HMAs) remain a therapeutic challenge. The CHG regimen has been demonstrated to be effective in initially treating higher risk MDS. The current study evaluated the efficacy and toxicity of the CHG regimen in patients who were resistant to decitabine.

Methods: Patients with higher risk MDS relapsed or refractory to decitabine were enrolled in this study. Each patient received the CHG regimen (cytarabine (25 mg/day, days 1-14) and homoharringtonine (1 mg/day, days 1-14) intravenously with G-CSF (300 μg/day) subcutaneously from day 0 until neutrophil count recovery to 2.0 × 109 cells/L). Next gene sequencing with a 31-gene panel was carried out in patients.

Results: Thirty-three patients were enrolled, including 12 relapsed and 21 refractory cases. The overall response rate (ORR) was 39.4% (13 of 33), with 9 (27.3%) achieving complete remission (CR), 2 having marrow CR (mCR), and 2 achieving partial remission (PR). The CR rate was higher in patients harboring fewer gene mutations (0-1) (55.6%) than in those with more gene mutations (> 1) (12.5%) (p = 0.021). The median overall survival (OS) of the 33 patients was 7.0 months. Patients who achieved a response had significantly longer survival times than were found in those without a response (21.0 M vs. 4.0 M, p < 0.0001). The regimen was endurable for most of the patients.

Conclusions: The CHG priming regimen provided a safe and effective salvage regimen for higher risk MDS patients who were resistant to decitabine. Further studies involving larger samples will be needed. Clinical trial No. ChiCTR-ONC-11001501.

Keywords: Cytarabine; Decitabine; Granulocyte colony-stimulating factor (G-CSF); Homoharringtonine; Myelodysplastic syndromes.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cytarabine / adverse effects
  • Cytarabine / therapeutic use*
  • Decitabine / therapeutic use*
  • Female
  • Granulocyte Colony-Stimulating Factor / adverse effects
  • Granulocyte Colony-Stimulating Factor / therapeutic use*
  • Homoharringtonine / adverse effects
  • Homoharringtonine / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Mutation / drug effects
  • Myelodysplastic Syndromes / drug therapy*
  • Remission Induction / methods
  • Salvage Therapy / methods
  • Treatment Outcome

Substances

  • Cytarabine
  • Granulocyte Colony-Stimulating Factor
  • Homoharringtonine
  • Decitabine