Analysis Of The Efficacy And Safety Of Azacitidine In The Treatment Of Acute Myeloid Leukemia And Myelodysplastic Syndrome

Objective:To study the curative effects and security of azacitidine in the treatment of acute myeloid leukemia and myelodysplastic syndrome.Methods:The clinical data of 31 patients with AML/MDS diagnosed in our hospital from 2018.10 to 2021.02 were analyzed.Azacitidine was used alone or in combination with a total amount of 75mg/m~2 for 7 days,divided into 7-10 days of continuous subcutaneous injection,every 28-30 days as a course of treatment.The total remission rate(ORR),median survival time,adverse reactions and gene mutation were observed.Results:31 patients completed a total of 104 courses of treatment,the median course of treatment was 3(1-12),6 cases did not complete 2 courses of treatment were not included in the statistics.After 2 courses,the ORR was 72.0%(8.0%)in 2 cases of CR,16 cases of m CR(64.0%),5 cases of stable disease(20.0%),2 cases of treatment failure(8.0%),the mortality rate was 40.0%,and the median survival time was 8.5 months.The ORR of monotherapy and combination was 64.3%and 81.8%respectively,the median survival time was 7.25%and 9 months,the ORR of MDS and AML was 66.7%and 76.9%,the median survival time was 8 and 11 months,the ORR of≥60 years old and<60 years old was 66.7%and 80.0%,respectively,and the median survival time was 7 and 11.5 months.The ORR of MDS-EB-1 and MDS-EB-2 is 75.0%and62.5%,respectively,and the median survival time is 11.5 and 6.5 months.During 2courses and 4 courses,the transfusion dependence rates were 64.0%and 55.5%,respectively.Gene mutations were detected in 15 cases by second generation sequencing.The results showed that there were 14 cases of gene mutation,11 cases of TET2 mutation,6 cases of ASXL1 mutation,4 cases of NPM1 and DNMT3A mutation,2 cases of U2AF1,NRAS and IDH2 mutation,2 cases of RUNX1,IDH1,CEBPA,FLT3-ITD and GATA2,and 1 case of ETV6,SF3B1,KRAS,SETBP1,DNMT3A,BCOR,PHF6 and MLL.The ORR of TET2 and ASXL1 mutation was 54.5%and66.7%,respectively,and the median survival time was 13 and 11 months.During chemotherapy,the incidence of III-IV grade II blood toxicity was 88.0%.Grade II blood toxicity occurred in 12.0%,nausea and vomiting in 25 cases,constipation in 1 case,diarrhea in 2 cases,fever in 13 cases,pulmonary infection in 6 cases,liver function damage in 7 cases,renal function damage in 3 cases,hypokalemia in 6 cases,hypoalbuminemia in 10 cases,hyperuricemia in 2 cases,and peripheral nerve numbness in 1 case.Conclusion:Azacitidine is curative and secure in the treatment of AML and MDS,and the curative effect of combination therapy is better than that of single agent,but the side effects of combination therapy are greater.