Analysis Of The Short-term Efficacy Of Very Low Dose Dicitabine In The Treatment Of Myelodysplastic Syndrome In The Low And Intermediate Risk Groups

Objective:To evaluate the short-term efficacy and safety of very low-dose decitabine in the treatment of patients with low and intermediate risk group myelodysplastic syndrome(MDS),and to analyze the factors that may affect the therapeutic effect.Methods:Retrospective analysis of clinical data of 30 patients with myelodysplastic syndrome admitted to the first hospital of jilin university from November 2014 to November 2017 with few blasts(< 5%),no high-risk karyotype,increased EPO level,no chromosome 5q deletion and receiving very low dose of desicitabine in the low and intermediate risk groups,all patients were given decitabine 7-10mg/ ㎡ ·d×5d,continuous demethylation treatment for 2-4 courses to assess the overall response efficiency(ORR)and adverse reactions.The relevant factors that may affect the treatment effect were analyzed,and the patients in this group were followed up.The follow-up time was August 01,2018.Statistical analysis was performed using SPSS 19.0 software to calculate the cumulative survival rate of all patients.Results:1.There were more males than females in 30 patients with MDS in the low and intermediate risk group,with a male/female ratio of 2.3:1 and a median age of 51 years(19-78 years).2.Of the 30 patients with MDS,23 patients with multilineage pathological hematopoiesis(MDS-MLD),accounting for 76.7%,4 patients with ring-shaped iron granulocyte and multi-lineage hematopoietic(MDS-RS-MLD),accounting for 13.3%,3 patients with MDS failed to classify(MDS-U),accounting for 10%.3.Treatment protocol: 30 patients received informed consent after the informed consent.Decitabine(Jiangsu Haosen Pharmaceutical)has a therapeutic dose of 7-10 mg·㎡ for 5 consecutive days,and 28 days is a course of treatment.Each patient was given at least 2 courses of treatment,each interval of 4 weeks.4.After 2 cycles of treatment,the ORR was 66.7%,of which: CR was 23.3%(7/30),PR was 16.7%(5/30),HI was 26.7%(8/30),and SD+PD was 33.3%(10/30).After 4 cycles of treatment,the ORR was 70%,of which: CR was 23.3%(7/30),PR was 16.7%(5/30),HI was 30%(9/30),and SD+PD was 30%(9/30).5.Univariate analysis showed that patients with age,gender,risk stratification and whether or not to carry TET2 gene mutations did not affect the recent overall efficiency of decitabine treatment(P>0.05);6.The follow-up date was as of August 01,2018.The average follow-up time was 26 months.The cumulative survival rate of 30 patients was 90%.Conclusions:1.Very low dose of dicetabine is effective in the treatment of MDS in low and intermediate risk groups with few primordial cells(< 5%),no high-risk karyotype,increased EPO level and no chromosome 5q deletion,and can continue to receive decitabine after remission or hematologic improvement;2.Factors such as gender,age,risk stratification,and presence of TET2 gene mutations did not affect the short-term overall response rate of MDS in low and intermediate risk groups,but the number of cases enrolled in this study was small and deserved further study;3.Very low doses of decitabine during the treatment of severe cytopenia(grade Ⅲ-Ⅳ)and infection and other adverse reactions are low,and patients can tolerate,it is worthy of clinical trials to further clarify its significance.