Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2020; 8(22): 5603-5610
Published online Nov 26, 2020. doi: 10.12998/wjcc.v8.i22.5603
CLAG-M chemotherapy followed by umbilical cord blood stem cell transplantation for primary refractory acute myeloid leukaemia in a child: A case report
Jie Huang, Xiao-Yun Yang, Liu-Cheng Rong, Yao Xue, Jun Zhu, Yong-Jun Fang
Jie Huang, Xiao-Yun Yang, Liu-Cheng Rong, Yao Xue, Jun Zhu, Yong-Jun Fang, Department of Haematology and Oncology, Children’s Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
Author contributions: Huang J reviewed the literature and contributed to manuscript drafting; Yang XY, Rong LC and Xue Y collected clinical data and contributed to manuscript drafting; Zhu J performed laboratory analysis and drafted the manuscript; Fang YJ was responsible for the revision of the manuscript for important intellectual content; All authors issued final approval for the version to be submitted.
Supported by the National Natural Science Foundation of China, No. 81670155.
Informed consent statement: Written informed consent was obtained from the parents of the patient.
Conflict-of-interest statement: The authors state there is no conflict of interest.
CARE Checklist (2016) statement: Guidelines of the CARE Checklist (2016) have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yong-Jun Fang, MD, PhD, Chief Doctor, Dean, Department of Haematology and Oncology, Children's Hospital of Nanjing Medical University, No. 72 Guangzhou Road, Nanjing 210008, Jiangsu Province, China. fyj322@189.cn
Received: January 1, 2020
Peer-review started: January 1, 2020
First decision: September 29, 2020
Revised: October 5, 2020
Accepted: October 19, 2020
Article in press: October 19, 2020
Published online: November 26, 2020
Processing time: 329 Days and 1.6 Hours
Abstract
BACKGROUND

The prognosis of paediatric primary refractory/relapsed acute myeloid leukaemia (R/R AML) remains poor. Intensive therapy is typically used as salvage treatment for those with R/R AML. No data are currently available about the use of the CLAG-M protocol as salvage therapy in paediatric patients with R/R AML.

CASE SUMMARY

An 8-year-old patient was diagnosed with acute myeloid leukaemia by bone marrow morphology and immunophenotype. The patient showed poor response to two cycles of induction therapy with 60% blast cells in the bone marrow after the second induction cycle. The patient achieved complete remission after being treated with the CLAG-M protocol as salvage therapy before undergoing umbilical cord blood stem cell transplantation. Morphological complete remission with haematological recovery has hitherto been maintained over 4 mo. Abnormal gene mutations detected at diagnosis were undetectable after haematopoietic stem cell transplantation.

CONCLUSION

Here we present a paediatric patient with primary refractory acute myeloid leukaemia who was successfully treated with the CLAG-M protocol. Given the positive results of the presented patient, large-scale clinical studies are required to assess the role of the CLAG-M protocol in the salvage treatment of refractory or relapsed AML in childhood.

Keywords: Acute myeloid leukaemia; CLAG-M protocol; Salvage therapy; Refractory; child; Case report

Core Tip: The outcome of refractory/relapsed acute myeloid leukaemia (R/R AML) in childhood remains poor. A boy with primary refractory AML achieved complete remission (CR) after being treated with one cycle of the CLAG-M protocol as salvage therapy. Umbilical cord blood stem cell transplantation was carried out after CR. The patient remains in complete remission without previous genetic abnormalities. The CLAG-M protocol might be an effective and tolerable salvage regimen and a bridge to haematopoietic stem cell transplantation in R/R AML. Additionally, we focus our literature review on the role of cladribine-based protocols in paediatric and adult R/R AML patients.