Objective To investigate the efficacy and safety of decitabine + cytarabine + acclarithromycin + granulocyte colony stimulating factor (DCAG) regimen in the treatment of refractory recurrent lymphoid neoplasm.

Methods  A retrospective analysis was conducted on 6 patients with refractory relapsed lymphoid neoplasm in the department of hematology, Yan'an University Affiliated Hospital from January 2020 to December 2021, and to evaluate the curative effect.

Results  Among all the cases, 4 cases were with B-acute lymphoblastic leukemia (B-ALL), 1 case was with diffuse large B-cell lymphoma and 1 case was with peripheral T-cell lymphoma. After 1 course of induction chemotherapy, the overall response rate of the patients was 100%, and the adverse reactions were mainly the erythrocyte leukocyte and thrombocytopenia and corresponding complications that all patients in hematology department would appear after chemotherapy, which could be corrected by symptomatic treatment.

Conclusion  DCAG regimen is effective and safe in the treatment of refractory recurrent lymphoid neoplasm, but the number of the cases is small, and more clinical cases need to be collected.

1.Xu Q, Li Y, Jing Y, et al. Epigenetic modifier gene mutations-positive AML patients with intermediate-risk karyotypes benefit from decitabine with CAG regimen[J]. Int J Cancer, 2020, 146(5): 1457-1467. DOI: 10.1002/ijc.32593.

2.中国抗癌协会血液肿瘤专业委员会,中华医学会血液学分会白血病淋巴瘤学组.中国成人急性淋巴细胞白血病诊断与治疗指南（2021年版）[J].中华血液学杂志, 2021, 42(9): 705-716. [Hematology and Oncology Committee of China Anti-Cancer Association, Leukemia Lymphoma Group, Society of Hematology, Chinese Medical Association. Chinese guidelines for diagnosis and treatment of adult acute lymphoblastic leukemia (2021)[J]. Chinese Journal of Hematology, 2021, 42(9): 705-716.] DOI: 10.3760/cma.j.issn.0253-2727.2021.09.001.

3.Dada R. Diagnosis and management of follicular lymphoma: a comprehensive review[J]. Eur J Haematol, 2019, 103(3): 152-163. DOI: 10.1111/ejh.13271.

4.Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification[J]. J Clin Oncol, 2014, 32(27): 3059-3068. DOI: 10.1200/JCO.2013.54.8800.

5.Liu MK, Sun XJ, Gao XD, et al. Methylation alterations and advance of treatment in lymphoma[J]. Front Biosci(Landmark Ed), 2021, 26(9): 602-613. DOI: 10.52586/4970.

6.Xu Q, Li Y, Jing Y, et al. Epigenetic modifier gene mutations-positive AML patients with intermediate-risk karyotypes benefit from decitabine with CAG regimen[J] Int J Cancer, 2020, 146(5): 1457-1467. DOI: 10.1002/ijc.32593.

7.Nordlund J, Syvänen AC. Epigenetics in pediatric acute lymphoblastic leukemia[J]. Semin Cancer Biol, 2018, 51: 129-138. DOI: 10.1016/j.semcancer.2017.09.001.

8.Maćkowska N, Drobna-Śledzińska M, Witt M, et al. DNA methylation in T-cell acute lymphoblastic leukemia: in search for clinical and biological meaning[J]. Int J Mol Sci, 2021, 22(3): 1388. DOI: 10.3390/ijms22031388.

9.Li X, Liu L, Zhang Y, et al. Efficacy of cytarabine, aclarubicin and granulocyte colony-stimulating factor (CAG) regimen compared to FLAG regimen for adult patients with relapsed/refractory Philadelphia chromosome-negative acute lymphoblastic leukemia[J]. Leukemia Research, 2015, 39(11): 1201-1206. DOI: 10.1016/j.leukres.2015.08.013.

10.吴艳玲,薛胜利,孙爱宁,等. CAG方案清除T细胞急性淋巴细胞白血病细胞株A3细胞作用机制的研究[J].中国实验血液学杂志, 2008, 16(6): 1279-1282. [Wu YL, Xue SL, Sun AN, et al. Mechanism of CAG regimen eliminating T-cell acute lymphoblastic leukemia A3 cell line[J]. Journal of Experimental Hematology, 2008, 16(6): 1279-1282.] https://d.wanfangdata.com.cn/periodical/ChlQZXJpb2RpY2FsQ0hJTmV3UzIwMjMxMjI2EhJ6Z3N5eHl4enoyMDA4MDYwMDcaCGxoemJmY2ps

11.薛胜利.预激方案对难治、复发ALL治疗的临床及机制研究[D].苏州:苏州大学, 2011. [Xue SL. A study of the priming regimen's efficacy and mechanism in eradicating leukemic cells when applied on refractory and relapsed ALL[D]. Suzhou: Suzhou University, 2011.] DOI: 10.7666/d.y1991859.