Treatment Of Children With Refractory Acute Lymphoblastic Leukemia With IHDA Regimen

BackgroundThe recurrence rate of children with acute lymphoblastic leukemia(ALL)is still high up to 20%.The remission of induction therapy is very difficult after relapse,especially for refractory ALL.Allogeneic hematopoietic stem cell transplantation(allo-HSCT)is the main method to achieve long-term disease-free survival for children with refractory ALL,but the effect can be influenced seriously whether or not remission before transplantation.Therefore,it is necessary to explore effective induction regimen to create conditions for allo-HSCT.ObjectiveTo observe the efficacy and adverse effect of IHDA(Idarubicin + High-dose Cytarabine)as a remedy regimen in the treatment of pediatric patients with refractory ALL.MethodsTwelve children with refractory ALL were treated by IHDA regimen as follows: IDA,10mg/(m2.d),d1-3;Ara-C,1.0g/m2,q12 h,d1-3.The children who achieved complete remission(CR)can get into the following sequential regimens or allo-HSCT.The same regimen was given the children who didn’t achieved CR when WBC>2.0×109/L.The efficacy and hematology or non-hematology adverse effect were evaluated.Results1.CR/partial remission(PR)/non-remission(NR)was respectively 4/3/5 cases after given the first regimen and CR/PR/NR was respectively 5/3/4 cases after given the second regimen.The overall remission was 66.7%(8/12 cases),of which 5 cases(41.7%)achieved complete remission and 3 cases(25%)reached partial remission.2.Grade Ⅳmyelosuppression occurred in all patients,but no severe infection and hemorrhage happened after the application of G-CSF,platelet transfusion and anti-infection treatment.Some reversible side effects as gastrointestinal adverse reaction,liver toxicity and myocardial damage observed in some patients.There is no chemotherapy related mortality in all the patients.Among the remaining 7 cases,3 cases were forced to hematopoietic stem cell transplantation,2 cases abandoned treatment and 2 cases lost to follow-up.3.Two cases relapsed again followed up to October 2015.One was achieved complete remission after applying chimeric antigen receptor T-cell immunotherapy and allo-HSCT now.Another was dead after applying FLAG save regimen.The other 3 cases achieved CR 26,10,4 months,respectively.ConclusionThe IHDA regimen is a well-effective and tolerated treatment for pediatric patients with refractory ALL,and could create an opportunity for the application of allo-HSCT.