Evaluation Of The Efficacy Of Ultra-low Dose Decitabine Combined With Chemotherapy In The Treatment Of High-risk Myelodysplastic Syndrome

Objective:A retrospective analysis of efficacy and adverse reactions of ultra-low dose decitabine combined chemotherapy and low-dose decitabine combined chemotherapy in the treatment of in patients with high-risk myelodysplastic syndrome.Methods:From January 2016 to December 2018,23 cases of high risk MDS treated with ultra-low dose decitabine combined with CAG/ HAG/ DA and 23 cases of high risk MDS treated with low dose decitabine combined with CAG/ HAG were collected in the Department of Hematology,the third people’s Hospital of Bengbu City.After one course of treatment,the overall effective(ORR)and the incidence of adverse reactions were compared between the two groups.The overall effective rate included complete remission rate,(CR),partial remission rate,(PR),disease stability rate,(SD).Results:23 patients(3 females,20 males,mean age 70.61±14.096 years)were treated with ultra-low dose decitabine combined with CAG/HAG/DA.There were 23 cases of MDS treated with low dose decitabine combined with CAG/HAG,including 1 case of female and 22 cases of male,the mean age was 63.52±9.567 years old.The total reaction rate of ultra-low dose decitabine group was 87.0%(20 / 23),including complete remission rate was 8.7%(2/23),partial remission rate and stable condition were 78.3%(18/23).The total reaction rate was 82.6%(19 / 23)in the low dose decitabine group,including complete remission rate was 21.7%(5/23),partial remission rate and stable condition rate were 60.9%(14/23).There was no significant difference in the complete remission rate between the two groups(P=0.218),and there was no significant difference in the total response rate between the two groups(P=0.681).The adverse reaction rates were73.9%(17 / 23)and 95.7%(22 / 23)in the ultra-low dose decitabine group and low-dose decitabine group respectively.There was a significant difference between the two groups(P =0.040).In addition,there were 2 therapeutic regimens in the ultra-lowdose decitabine group,and 14 high-risk MDS patients were treated with the first regimen.The complete remission rate was 14.3%(2 / 14)after one course of treatment.The rate of partial remission and disease stabilization was 78.6%(11 / 14),and the incidence of adverse reactions was 71.4%.The complete remission rate was 0(0 / 9),the partial remission rate was 66.7%(6 / 9)and the adverse reaction rate was 77.8%after one course of treatment in 9 high-risk MDS patients treated with the second regimen.There was no significant difference in complete remission rate(P =0.502),partial remission(P =0.643)and overall effective rate(P =0.260)between the two regimens.There was no significant difference in the incidence of adverse reactions(P=1.000).Conclusion:The efficacy and side-effects of ultra-low dose decitabine combined with CAG/HAG/DA regimen in patients with high-risk myelodysplastic syndrome are similar to those of low-dose decitabine combined with CAG/ HAG regimen.We can consider using this regimen to treat high-risk MDS,especially for elderly high-risk MDS patients who are in poor physical condition and can not tolerate high-dose chemotherapy and hematopoietic stem cell transplantation(HSCT).