Epigenetic Priming with Decitabine Followed by Low Dose Idarubicin and Cytarabine in Acute Myeloid Leukemia Evolving from Myelodysplastic Syndromes and Higher-Risk Myelodysplastic Syndromes: a Prospective Multicenter Single-Arm Trial

Patients with acute myeloid leukemia (AML) evolving from myelodysplastic syndrome (MDS) or higher-risk MDS have limited treatment options and poor prognosis. Our previous single-center study of decitabine followed by low dose idarubicin and cytarabine (D-IA) in patients with myeloid neoplasms showed promising primary results. We therefore conducted a multicenter study of D-IA regimen in AML evolving from MDS and higher-risk MDS. Patients with AML evolving from MDS or refractory anemia with excess blasts type 2 (RAEB-2) (based on the 2008 WHO classification) were included. The D-IA regimen (decitabine, 20 mg/m(2)daily, days 1 to 3; idarubicin, 6 mg/m(2)daily, days 4 to 6; cytarabine 25 mg/m(2)every 12 hours, days 4 to 8; granulocyte colony stimulating factor [G-CSF], 5 mu g/kg, from day 4 until neutrophil count increased to 1.0 x 10(9)/L) was administered as induction chemotherapy. Seventy-one patients were enrolled and treated, among whom 44 (62.0%) had AML evolving from MDS and 27 (38.0%) had RAEB-2. Twenty-eight (63.6%) AML patients achieved complete remission (CR) or complete remission with incomplete blood count recovery (CRi): 14 (31.8%) patients had CR and 14 (31.8%) had CRi. Six (22.2%) MDS patients had CR and 15 (55.6%) had marrow complete remission. The median overall survival (OS) was 22.4 months for the entire group, with a median OS of 24.2 months for AML and 20.0 months for MDS subgroup. No early death occurred. In conclusion, the D-IA regimen was effective and well tolerated, representing an alternative option for patients with AML evolving from MDS or MDS subtype RAEB-2.