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Analysis Of The Therapeutic Effect Of Decitabine Combined With CAG Regimen In The Treatment On 66 Elderly Patients With Acute Myeloid Leukemia

Posted on:2022-01-08Degree:MasterType:Thesis
Country:ChinaCandidate:H Y LiFull Text:PDF
GTID:2504306554489114Subject:Internal Medicine
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Objective:To explore the efficacy and safety of decitabine single agent,CAG(cytarabine+aclacinomycin+granulocyte colony stimulating factor)regimen and the combination of the decitabine and CAG in the treatment of acute myeloid leukemia(AML).Methods:From September 2014 to June 2020,66 elderly patients with newly diagnosed AML admitted to the Department of Hematology in Hebei General Hospital were collected.Among them,24 were treated with decitabine combined with CAG(D-CAG group)and 22 were treated with CAG(CAG group),20 were treated with Decitabine as a single agent(DAC group).The clinical data of the patients were retrospectively analyzed.Results:1.In the D-CAG group,there were 15 males and 9 females,with a median age of onset of 66.5.There were 15 males and 7 females in the CAG group.The median age of onset was 66.0.There were 14 males and 6 females in the DAC group,the median age of onset was 67.5.There were no statistically significant in comparison of baseline characteristics such as age,gender,albumin,risk stratification,bone marrow blasts and blood cell count at diagnosis(all P>0.05),and they were comparable.2.A total of 56 cases of 66patients completed the detection of common AML gene mutations through next-generation sequencing(NGS),of which 49 cases(87.5%)had positive results,16 cases(28.6%)had 1 mutation,15 cases(26.8%)combined 2 kinds of mutations,and 18 cases(32.1%)have 3 or more kinds of mutations.The most common top 5 gene mutations were:NPM1(17.9%),TET2(17.9%),ASXL1(16.1%),IDH2(14.3%)and DNMT3A(12.5%).3.The median course of treatment for the three groups of patients was 2 courses,and the complete remission(CR)rates were 50.0%,18.2%and 20.0%,respectively.The CR rate of the D-CAG group was significantly higher than that of the CAG group and the DAC group(P=0.036),the overall response rate(ORR)of the three groups was 79.2%,63.6%and 65.0%,respectively,and there was no statistically difference(P>0.05).4.The adverse reactions were mainly bone marrow suppression.The incidence of platelet suppression of grade III to IV in the D-CAG group and the CAG group was significantly higher than that of the DAC group(95.8%,95.5%and 65.0%,respectively,P=0.004),there was no significant difference in the incidence of other adverse reactions(fever,infection,bleeding and gastrointestinal symptoms)between the D-CAG group and the CAG group,but the incidence of fever and infection in the DAC group was significantly lower than that of the other two groups.5.None of the patients were lost to follow-up.The median follow-up period was 8 months.Among the patients in the D-CAG group,15 died.The median overall survival(OS)was 8 months.In the CAG group,18 died.The median OS was7 months.In the DAC group,10 died.The median OS was 8 months.There were no statistically significant differences in OS among the three groups(P>0.05).The six-month survival rates of the three groups were 83.3%,54.5%,and 50.0%,respectively,the D-CAG group was significantly higher than the other two groups(P=0.040).6.The influencing factors of 56 patients were analyzed,Logistic regression analysis were performed on the single factor(white blood cell count and TET2 mutation)with statistical significance in ORR.It was found that the white blood cell count and TET2 mutation were independent influencing factors of OR for patients received decitabine monotherapy,CAG regimen or the combination of the two in the treatment of patients with AML.The white blood cell count≥10×10~9/L and TET2 mutation positive might be adverse prognostic factors.Conclusions:1.The complete remission rate of the D-CAG group was significantly higher than that of the CAG group and the DAC group.The complete remission rate of the latter two groups was similar,and the overall remission rate of the three groups had no significant difference.2.Among 56 patients with common gene mutations detected by NGS,49patients(87.5%)had positive results,and 33 patients(58.9%)had 2 or more mutations,the most common top 5 gene mutations are:NPM1、TET2、ASXL1、IDH2 and DNMT3A。3.There was no significant difference in the incidence of fever,infection,bleeding and gastrointestinal symptoms between the D-CAG group and the CAG group.4.There was no significant difference in overall survival among the three groups,but the 6-month survival rate of patients in the D-CAG group was significantly higher than that of the other two groups.5.White blood cell count and TET2 mutation are independent factors influencing the overall remission rate of AML patients treated with decitabine monotherapy,CAG regimen or the combination of the two.The white blood cell count≥10×10~9/L and TET2 mutation positive might be adverse prognostic factors.6.The D-CAG chemotherapy regimen is safe and has a high complete remission rate should be widely used in the therapy of AML.
Keywords/Search Tags:Acute Myeloid Leukemia, Decitabine, CAG regimen, Hypomethylating agents
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