Combination of decitabine, idarubicin, cytarabine, and G-CSF (DIAG) regimen for the treatment of high-risk myelodysplastic syndrome and acute myeloid leukemia

  • Xueya ZhangEmail author
  • Xizhe Guo
Letter to the Editor

Dear Editor,

Sixty to eighty percent of patients with newly diagnosed acute myeloid leukemia (AML) can achieve complete remission (CR) after intensive chemotherapy. However, current therapy remains unsatisfactory for high-risk AML patients, including the elderly, relapsed, refractory, and secondary AML [1]. Myelodysplastic syndrome (MDS) comprises a very different group of myeloid malignancies with very distinct natural histories. Interventions have been evolved significantly over the last decade in high-risk disease. However, the median survival of these patients was only 0.5 years [2]. Generally, the effect of intensive chemotherapy on these patients is insufficient because of drug resistance, poor performance status (PS), dysfunction of multiple organs, and high treatment-related toxicities, leading to high early death (ED) rate. Novel agents and regimens have been developing for this group of patients with AML and high-risk MDS [3, 4, 5, 6].

The combination of new drugs and...


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Löwenberg B, Downing JR, Burnett A (1999) Acute myeloid leukemia. New Engl J Med 341(14):1051–1062CrossRefGoogle Scholar
  2. 2.
    Adès L, Itzykson R, Fenaux P (2014) Myelodysplastic syndromes. Lancet. 383(9936):2239–2252CrossRefGoogle Scholar
  3. 3.
    Klco JM, Spencer DH, Lamprecht TL, Sarkaria SM, Wylie T, Magrini V, Hundal J, Walker J, Varghese N, Erdmann-Gilmore P, Lichti CF, Meyer MR, Townsend RR, Wilson RK, Mardis ER, Ley TJ (2013) Genomic impact of transient low-dose decitabine treatment on primary AML cells. Blood 121(9):1633–1643CrossRefGoogle Scholar
  4. 4.
    Kantarjian HM, Thomas XG, Dmoszynska A, Wierzbowska A, Mazur G, Mayer J, Gau JP, Chou WC, Buckstein R, Cermak J, Kuo CY, Oriol A, Ravandi F, Faderl S, Delaunay J, Lysák D, Minden M, Arthur C (2012) Multicenter, randomized, open-label, phase III trial of decitabine versus patient choice, with physician advice, of either supportive care or low-dose cytarabine for the treatment of older patients with newly diagnosed acute myeloid leukemia. J Clin Oncol 30(21):2670–2677CrossRefGoogle Scholar
  5. 5.
    Qin T, Youssef EM, Jelinek J, Chen R, Yang AS, Garcia-Manero G, Issa JPJ (2007) Effect of cytarabine and decitabine in combination in human leukemic cell lines. Clin Cancer Res 13(14):4225–4232CrossRefGoogle Scholar
  6. 6.
    Shen L, Kantarjian H, Guo Y, Lin E, Shan J, Huang X, Berry D, Ahmed S, Zhu W, Pierce S, Kondo Y, Oki Y, Jelinek J, Saba H, Estey E, Issa JPJ (2010) DNA methylation predicts survival and response to therapy in patients with myelodysplastic syndromes. J Clin Oncol 28(4):605–613CrossRefGoogle Scholar
  7. 7.
    Lee JH, Jang JH, Park J, Park S, Joo YD, Kim YK, Kim HG, Choi CW, Kim SH, Park SK, Park E, Min YH (2011) A prospective multicenter observational study of decitabine treatment in Korean patients with myelodysplastic syndrome. Haematologica. 96(10):1441–1447CrossRefGoogle Scholar
  8. 8.
    Li J, Chen Y, Zhu Y, Zhou J, Xu Y, Li Y, Yu K, Pan L, Wang J, Ding J, Gu J, Zhou S, Shi J, Hong M, Xu J, Pan L, Duan L, Zhang R, Zhang S, Zhu H, Lu H, Liu P, Qiu H, Wu H, Qian S (2015) Efficacy and safety of decitabine in combination with G-CSF, low-dose cytarabine and aclarubicin in newly diagnosed elderly patients with acute myeloid leukemia. Oncotarget 6:6448–6458Google Scholar
  9. 9.
    Tefferi A, Guglielmelli P, Larson DR, Finke C, Wassie EA, Pieri L, Gangat N, Fjerza R, Belachew AA, Lasho TL, Ketterling RP, Hanson CA, Rambaldi A, Finazzi G, Thiele J, Barbui T, Pardanani A, Vannucchi AM (2014) Long-term survival and blast transformation in molecularly annotated essential thrombocythemia, polycythemia vera, and myelofibrosis. Blood 124:2507–2513CrossRefGoogle Scholar
  10. 10.
    Kennedy JA, Atenafu EG, Messner HA, Craddock KJ, Brandwein JM, Lipton JH, Minden MD, Schimmer AD, Schuh AC, Yee KW, Gupta V (2013) Treatment outcomes following leukemic transformation in Philadelphia negative myeloproliferative neoplasms. Blood 121:2725–2733CrossRefGoogle Scholar
  11. 11.
    Rumi E, Pietra D, Ferretti V, Klampfl T, Harutyunyan AS, Milosevic JD, Them NCC, Berg T, Elena C, Casetti IC, Milanesi C, Sant'Antonio E, Bellini M, Fugazza E, Renna MC, Boveri E, Astori C, Pascutto C, Kralovics R, Cazzola M, on behalf of the Associazione Italiana per la Ricerca sul Cancro Gruppo Italiano Malattie Mieloproliferative Investigators (2014) JAK2 or CALR mutation status defines subtypes of essential thrombocythemia with substantially different clinical course and outcomes. Blood 123:1544–1551CrossRefGoogle Scholar
  12. 12.
    Gangat N, Wolanskyj AP, McClure RF et al (2007) Risk stratification for survival and leukemic transformation in essential thrombocythemia: a single institutional study of 605 patients. Leukemia 21:270–276CrossRefGoogle Scholar

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© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of HematologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina

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