| Objective:Acute myeloid leukemia?AML?is a malignant hematopoietic proliferative disease,which is mainly caused by abnormal proliferation,differentiation,and cloning of blood,bone marrow,and other tissues.Acute myeloid leukemia commonly occurs in adults that account for 90%cases,but only 15%-20%in children[1].Although it was considered incurable 50 years ago,with the development of medical,about 35%to 40%of adult patients?age?60 years old?and 5%to 15%of elderly patients?>60 years old?can be cured nowadays,but the older patients who underwent high-intensity chemotherapy and refractory and relapsed patients showed an average median survival of only 5 to 10 months.Therefore,there is a need for new treatments with different mechanisms.It has been found that the occurrence and development of acute leukemia and epigenetic changes are closely related.This study provides a more open idea for the treatment of AML.Studies show that although some types of leukemia do not response well to cytotoxic chemotherapeutic drugs.Decitabine acts as a DNA methyltransferase inhibitor,which is incapable of reactivating silent genes and inducing further differentiation and maturation of leukemic cells.[2,3],However the effect of decitabine alone is very limited.At present,the clinical application of decitabine combined with CAG?cytarabine+clarithromycin+recombinant human granulocyte growth factor?in the treatment of AML has been extensive,but the efficacy and safety remain controversial.Therefore,We aim to compare the clinical efficacy and safety in the treatment of AML by Meta analysis.Methods:The studies were retrived from Pubmed,Web of Science,EMBASE,China Knowledge Network?CNKI?,Wanfang Database,VIP Database,and China Biomedical Literature Database.Literature about the clinical efficacy and safety of decitabine combined with CAG chemotherapy,published in Chinese or English from January 2010to October 2017,are collected.Unrelated and inconsistent literatures were excluded.The date were extracted and analyzed using Revman 5.3 version and Stata 12.0 version.Results:Twenty-seven articles were included in this study,including 1,586 cases of acute myeloid leukemia.They were divided into experimental group?DAC combined with CAG regimen?and control group?CAG regimen alone?.The results showed that the experimental group had better complete remission rate?RR=1.70,95%CI=1.50-1.90,P<0.00001?and total effective rate?RR=1.43,95%CI=1.33-1.53,P<0.00001?than the control group.In terms of safety,the experimental group had a lower incidence of thrombocytopenia and alopecia?RR=0.43,95%CI=0.25-0.74,P=0.02 and RR=0.53,95%CI.=0.3-0.95,P=0.03?.At the same time,the experimental group also had higher incidence of fever,pulmonary infection,and nausea and vomiting?RR=2.55,95%CI=1.50-1.90,P<0.00001 and RR=1.43,95%CI.=1.21-1.69,P<0.00001and RR=1.51,95%CI=1.21-1.88,P=0.0003,respectively?.But there was no significant difference in liver function impairment and diarrhea between the two groups?RR=0.95,95%CI=0.67-1.34,P=0.77 and RR=0.70,95%CI=0.48-1.02,P=0.06?,respectively.Conclusion:Decitabine combined with CAG regimen can significantly improve the total effective rate and complete remission rate in the treatment of acute myeloid leukemia with lower incidence of thrombocytopenia and alopecia than CAG regimen alone.However,decitabine combined with CAG regimen can also increase the incidence of fever,lung infection,nausea and vomiting than CAG regimen alone. |
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