Objective  To compare the safety and efficacy of decitabine combined with unrelated umbilical cord blood transplantation and traditional regimen in the elderly patients with acute myeloid leukemia (AML) after achieving complete remission with induction therapy.

Methods  Fifty-two elderly AML patients who obtained complete remission (CR) after 1-2 cycles of induction therapy in the Department of Hematology of Yancheng First People's Hospital and the Huai'an First Hospital Affiliated to Nanjing Medical University from January 2019 to January 2022 were enrolled, and were divided into the observation group (n=24) and the control group (n=28). The observation group received decitabine combined with unrelated umbilical cord blood transplantation, and the control group received traditional consolidation therapy, including azacitidine+vinblastine, idarubicin+cytarabine (IA), or aclarubicin+cytarabine+granulocyte colony-stimulating factor, and so on. The hematopoietic recovery time, adverse reactions, relapse-free survival (RFS), and overall survival (OS) were compared between the two groups.

Results  The median recovery time of neutrophils was 12.54 d in the observation group and wes 18.64 d in the control group (P < 0.001); the median recovery time of platelets was 12.67 d in the observation group and was 19.71 d in the control group (P < 0.001). There was no difference in incidences of grade Ⅲ-Ⅳ myelosuppression and non-hematological toxicity between the two groups. There were statistical differences in the median RFS (33 months vs 11 months) and OS (36 months vs 24 months) between the observation group and the control group (P < 0.05).

Conclusions  Compared with the traditional consolidation regimen, decitabine combined with unrelated umbilical cord blood transplantation for consolidation of AML after achieving remission is more effective in elderly patients, could prolong survival, and has similar safety.