Treatment of an elderly patient with acute myelocytic leukemia transformed from myelodysplastic syndrome with decitabine in ultra-low dosage combining with transfusion of autologous cytokineinduced killer cells:a case report and review of literature

Objective　To investigate the efficacy and safety of decitabine in ultra-low dose combining with autologous cytokine-induced killer (CIK) cells for treatment of elderly patients with acute myelocytic leukemia (AML) transformed from myelodysplastic syndrome (MDS). Methods　An 83-year-old patient with initial diagnosis of MDS-RA was treated with amifostine combined with erythropoietin (EPO), and hemogram was improved nearly to normal lasting about three and a half years. Then the patient's morbidity transformed to chronic myelomonocytic leukemia (AML-M4) two months later. Then the patient was treated with an ultra-low dose of decitabine combining with autologous CIK cells. The detailed treatment included decitabine 10mg, d1-5, and CIK cells transfusion (2×109-8×109 each time) d14; rhIL-2 2mU d15-19. 28-day treatment was accounted as one treatment course. Side effects, changes in hemogram, signs of recuperation and duration of survival were systematically observed. Further, the literature concerning decitabine for the treatment of elderly patients with MDS/AML was reviewed. Results　In total, 8 cycles of decitabine combining with autologous CIK cells were given in addition to the best supportive treatments available. During treatment, side reactions including Ⅰ/Ⅱ grade bone marrow inhibition and grade Ⅰ gastrointestinal reaction were observed. No obvious signs of dysfunction were found in liver and kidney. Leukocytosis appeared during 2nd, 3rd and 8th cycles of treatment, with the highest white blood cells count of 141.95×109/L, and it could be controlled by giving etoposide (50mg, d1-3). Hemoglobin content varied between 77 and 138g/L in the context of intermittent blood transfusion. During 3rd treatment, platelets started to increase in number, but reaching normal level during 6th treatment cycle. It was evaluated as partial remission. Finally, the patient died due to deterioration in leukemia and pneumonia. The overall survival duration was 22 months from diagnosis of AML to death, and it was significantly longer than that reported before. Conclusion　The treatment consisting of ultra-low dose of decitabine combining with autologous CIK cells, is safe and effective in treatment of elderly patients with AML transformed from MDS. Further investigation with more patients is warranted in the future. DOI: 10.11855/j.issn.0577-7402.2014.04.13