# In vitro drug sensitivity and clinical efficacy of the HAG regimen in pediatric AML

## TL;DR

This study shows that the HAG regimen is effective and less toxic for treating pediatric AML, achieving high remission and survival rates.

## Contribution

The study evaluates the HAG regimen's efficacy in pediatric AML, a population where it has been underexplored.

## Key findings

- The HAG regimen achieved a 75% complete remission rate in pediatric AML patients after one cycle.
- Patients with ELN favorable and intermediate risk achieved a 100% complete remission rate.
- The 3-year overall survival rate was 75.0% ± 8.8% with the HAG regimen.

## Abstract

Standard induction chemotherapy for acute myeloid leukemia (AML) using cytarabine combined with anthracyclines (epirubicin/IA or daunorubicin/DA) is effective but associated with severe adverse effects. The HAG regimen (low-dose homoharringtonine, cytarabine, G-CSF), known for lower toxicity, shows promise in adult AML, but its application in pediatric AML remains underexplored.

This study investigated the feasibility and efficacy of the HAG regimen in pediatric AML. Twenty-four newly diagnosed pediatric AML patients (excluding M3 subtype) were enrolled between August 2021 and November 2022. Patients received the HAG regimen as induction therapy. Drug sensitivity testing was performed to evaluate in vitro efficacy.

After the first induction cycle with HAG, the overall complete remission (CR) rate was 75% (18/24). Patients classified as ELN favorable and intermediate-risk achieved a 100% CR rate. The 1-year overall survival (OS) rate was 83.3% ± 7.6%, and the 3-year OS rate was 75.0% ± 8.8%. The 1-year event-free survival (EFS) rate was 75.0% ± 8.8%, and the 3-year EFS rate was 66.1% ± 9.8%.

The HAG regimen demonstrates high efficacy and holds great promise for pediatric AML. It achieves survival outcomes comparable to more intensive regimens while offering the significant advantage of reduced toxicity.