Analysis Of The Efficacy Of Demethylation Combined With Yisui Granules In The Treatment Of High-risk Myelodysplastic Syndrom

BackgroundMyelodysplastic syndrome,as a senile disease,86.4%of patients with this syndrome were over 60 years old when they were diagnosed,and the older they were,the higher the incidence rate was.Patients in the higher risk group tend to be older,and have physiological and pathological characteristics such as decreased physical function,impaired metabolism,multiple underlying diseases,chemotherapy intolerance,and genomic instability,resulting in a greater risk of progression to acute leukemia.Currently,for HR-MDS,allo-HSCT is still the only curable method,while demethylation therapy is the first line treatment option.However,due to the diverse clinical symptoms and complex pathogenesis of its patients,there are still some patients who cannot obtain satisfactory treatment results in clinical practice.Therefore,in the process of clinical diagnosis and treatment,how to "individualize" and"accurately"select appropriate treatment options for patients,effectively improve their quality of life,reduce drug toxicity,and prolong their survival time is currently an urgent research topic.Traditional Chinese medicine combined with Western medicine can achieve good clinical results in the treatment of HR-MDS,improve the patient’s basic status,increase the efficacy,and decrease adverse reactions.ObjectiveBy sorting out the clinical data of HR-MDS patients treated with demethylation combined with Yisui Granule in combination with traditional Chinese and western medicine,we summarized and analyzed the effective rate and total survival period after different courses of treatment under the treatment of combination of traditional Chinese and western medicine,and explored the relationship between TCM syndrome types,various laboratory test indicators,and survival period,"And whether there are differences in clinical efficacy and adverse reactions between two demethylated drugs,descitabine and azacytidine,in combination with Yisui Granule,in order to identify the relevant factors that affect the survival period of patients,and provide a certain clinical basis for the treatment of patients with myelodysplastic syndrome in the high-risk group with demethylated and Yisui Granule combined with traditional Chinese and western medicine,with a view to continuously optimizing the treatment plan and using both traditional and western medicine,",Improve the quality of life and prolong the survival period of patients with myelodysplastic syndrome in the high-risk group.MethodsReview and observe the clinical data of 31 patients with myelodysplastic syndrome in the higher risk group treated with demethylation combined with Yisui Granule in combination with traditional Chinese and Western medicine.Use SPSS 25.0 to analyze the relationship between traditional Chinese medicine syndrome types,clinical basic information,and survival time,as well as whether there are differences in clinical efficacy and adverse reactions between the two demethylation drugs,descitabine and azacitidine,combined with Yisui Granule in the treatment.ResultsAmong the 31 patients observed,demethylation combined with Yisui Granule was used in combination with traditional Chinese and Western medicine,including 16 cases in the dexcitabine group and 15 cases in the azacytidine group;Cases of deficiency of both spleen and kidney,toxin and blood stasis syndrome;There were 8 cases of hyperactivity of pathogenic heat and stagnation of toxin and blood stasis;20 cases of deficiency of both qi and yin,toxin and blood stasis syndrome.As of February 28,2023,a total of 8 people were alive and 23 died.Based on the analysis of clinical data,(1)in terms of TCM syndrome types and laboratory examination indicators,the platelet count in patients with deficiency of both qi and yin and toxin stasis block syndrome was significantly higher than that in patients with exuberant pathogenic heat and toxin stasis block syndrome(P<0.05).(2)In terms of clinical efficacy,demethylation combined with Yisui Granule combined with traditional Chinese and Western medicine has an ORR of 22.6%after one course of treatment,63.0%after three courses of treatment,and 60.9%after six courses of treatment.After three courses of treatment,the neutrophil count in the dexcitabine group is significantly higher than that in the azacytidine group(P<0.05),and the total effective rate of traditional Chinese medicine clinical efficacy is 82.6%.(3)In terms of survival,the median survival period for patients aged≤75 years was 19 months,and for patients aged>75 years,the median survival period was 10 months.Age>75 years old,ECOG>2 points,syndrome differentiation of traditional Chinese medicine as exuberant pathogenic heat,toxin stasis syndrome,failure to reach OR after three treatment courses,platelet count≤50×Factors such as 109/L and concomitant diseases≥4 can significantly reduce the survival period of patients(P<0.05).The median survival time of patients with SF3B1 mutations was significantly higher than that of patients without SF3B1 mutations(P<0.05).(4)In terms of adverse reactions,patients treated with demethylation combined with Yisui Granule in combination with traditional Chinese and Western medicine experienced severe bone marrow suppression,compare the bone marrow suppression in the dexcitabine group and azacitidine group,there was no statistically significant difference between the two groups(P>0.05).The most common non hematological adverse reactions-are infections,with pulmonary infections being the most common.Conclusion1.There is a certain relationship between TCM syndrome types and peripheral blood platelet counts.The platelet counts in patients with exuberant pathogenic heat and toxin stasis block syndrome groups are lower.Therefore,during clinical treatment,patients with exuberant pathogenic heat and toxin stasis block syndrome should pay special attention to whether there are bleeding signs,and should be given timely and active support treatment,using traditional Chinese medicine to replenish qi,replenish blood,and stop bleeding.2.The combination of demethylation and Yisui granules with traditional Chinese and Western medicine is an optimized plan for treating MDS in the high-risk group.The survival period of patients is higher than that of patients treated with demethylation alone,and it can be promoted and applied;Yisui Granule can significantly improve the clinical symptoms of traditional Chinese medicine in high-risk group patients with myelodysplastic syndrome;When using dexamethasone in clinical practice,especially for older patients,low dose regimens can be given priority.3.Age,ECOG score,TCM syndrome differentiation,platelet count,and associated diseases are correlated with patient survival,and special attention needs to be paid in clinical diagnosis and treatment.