Observation On The Efficacy And Influencing Factors Of Decitabine In ITP Patients With Steroid Therapy Failure

Objective:To evaluate the efficacy and influencing factors of decitabine(DAC)in primary immune thrombocytopenia(ITP)with corticosteroid therapy failure.Methods:This study retrospectively analyzed the data of sixty-one patients with ITP who has been failed in corticosteroid thepary(was ineffective,or was effective but replased)and were treated with low-dose decitabine(DAC)for at least 3 cycles from November 2015 to June 2021 in Department of Hematology,Qilu Hospital of Shandong University.The platelet counts before and after the treatment,the overall response(OR)rate,the complete response(CR)rate,the response(R)rate,the response time,the maintenance time,the recurrence time and the other relevant indicators were analyzed.The correlation of their gender,age,disease stage,hormone reactivity,platelet count before treatment,previous treatment regimen and other indicators were also analyzed.The data analysis and graphing are completed by SPSS24.0 and Graphpad Prism 9.4.0.The continuous variables were represented by "M(range)" using M-W rank sum test,the categorical variables were expressed in the number of cases and percentage by Chi square test and Fisher exact test,and the correlation was compared by binary logistic regression(P<0.05).Results:Among the 61 patients,the overall response(OR)rate was 45.90%(28/61);the complete response rates(CR)were 12/61(19.67%);the response rates(R)were 16/61(26.23%),respectively.Patients who had response to corticosteroids had a significantly higher probability to achieve R(P=0.003).Patients with higher platelet count before treatment had a higher probability to achieve R(P=0.016,respectively).In the patients with DAC as the second-line therapy and DAC as the third-line therapy,the difference between the two groups of their platelet count in the two cycles after the treatment was significant(P=0.047).The total effective rate of DAC as the second-line therapy was higher than that of third-line group at each detection time point,but there was no statistically significant difference in the total effective rate(P=0.066).Compared with the corticosteroid ineffective group,the platelet count was significantly increased in the corticosteroid-effective group after 2 and 3 cycles of decitabine treatment(P=0.032,0.024).There is a significant correlation between corticosteroid responsiveness and DAC clinical effect(OR value:9.213,95%CI:1.937-43.82,P=0.005).Conclusion:Decitabine is effective in treating ITP patients with steroid therapy failure,and the adverse reaction is mild.Although the curative effect of DAC for second-line therapy is higher than that of DAC for third-line therapy,the difference was not statistically significant.The effect of DAC treatment appears higher in patients with response to corticosteroid and those with higher platelet count before treatment,and the corticosteroid responsiveness has certain predictive value for the clinical effect of decitabine.