Comparison Of Efficacy And Safety Of Decitabine Versus Standard Chemotherapy In Treatment Of Acute Myeloid Leukemia In Elderly Patients

ObjectiveTo explore the efficacy and safety of decitabine alone or combined with low-intensity chemotherapy regimen for the treatment of newly diagnosed AML in older patients and to compare them with the standard chemotherapy based on AA regimen. Meantime, the prognosis was analyzed.MethodsThe clinical data of 29 newly diagnosed AML patients older than 60 years in the Department of comprehensive diagnosis and treatment center in the Institute of hematology & blood disease hospital, Peking union medical college from January 2014 to December 2015 were analyzed retrospectively.29 patients received different induction treatment, including 14 patients receiving decitabine alone or combined with low-intensity chemotherapy regimen,15 patients received standard induction chemotherapy based on AA protocol. The efficacy and safety was compared between the two groups and the prognostic factors were evaluated.ResultsBaseline characteristics of patients between the two groups were not statistically different except for initial white blood cell count and MDS history. The Overall response rate (ORR) of the two groups was 57.1%vs92.3% (p=0.077), and the complete response rate (CRR) was 42.9%vs76.9% (p=0.072). The ORR (44.44% vs.92.3%, respectively) and CRR (22.22% vs.76.92%, respectively) were superior following standard chemotherapy group vs. decitabine alone (P<0.05). Adverse events in the two groups mainly include grade 3~4 myelosuppression and serious infection. The amount of platelet transfusion in standard chemotherapy group was significantly higher than that of decitabine group (P= 0.037). Besides, the degree of bone marrow suppression, grade 3-4 infection incidence, red blood cell transfusion were higher as wellthough the difference was not statistically significant, which may be attributed to the small sample size. The median survival time of the two groups was 12and24 months respectively and 1 year survival rates were 37.8%vs.46.2%, the difference was not statistically significant (p=0.857). The proportion of blast cells(≥60%) and the count of white blood cell(WBC ≥10×109/L) in peripheral blood are adverse prognostic indicators (P< 0.05) for patients in decitabine(alone or combined with low-intensity chemotherapy) group, and have no significant impact on-the prognosis of standard chemotherapy group (P> 0.05).ConclusionDecitabine is effective and well tolerated in the elderly patients with newly diagnosed AML who were unsuitable for intensive chemotherapy and the tumor load is an adverse prognostic indicator. Though the ORR was lower than that of standard chemotherapy, our study suggest no difference in the outcome of survival. In view of the difference in the white blood cell count between the two groups, we believe that patients with high tumor load could benefit from the standard chemotherapy regimen in the case of tolerance. The treatment strategy of elderly patients with AML should be decided after a comprehensive evaluation. Patients with small tumor load and poor general conditions should be encouraged to receive decitabine and patients with good tolerance and high tumor load are more suitable for the application of standard chemotherapy.