Clinical Efficacy And Adverse Reactions Of Decitabine In The Treatment Of Myelodysplastic Syndrome

Background and objective:Myelodysplastic syndromes(MDS)is a group of malignant clonal diseases originating from hematopoietic stem cells.At present,the pathogenesis of MDS is not completely clear.With the deepening of epigenetics research,abnormal DNA methylation has been considered as one of the pathogenesis of MDS in human life,the demethylated drug decitabine has become a hot research topic.However,there is no uniform standard for its optimal dosage and treatment plan.In this study,we observed the efficacy and safety of the decitabine regimen in the treatment of MDS.The aim of this study was to explore the best regimen for the administration of decitabine,so as to provide some ideas for the treatment of MDS.Methods:Collecting 48 cases of middle and high risk MDS patients treated in Department of Hematology,first affiliated hospital of Bengbu Medical College(2014.01-2017.01).According to the different treatment options,32 cases were treated with decitabine monotherapy,the use of decitabine was 25mg/(m~2*d),during the first day to the fifth day,twenty-eight days a course and 16 patients were treated with decitabine combined with a half dose of CAG monotherapy,the use of decitabine was 25mg/(m~2*d),during the first day to the thirth day,to observe the curative effect and survival condition of the two groups of patients.Results:1.Among the 48 patients with middle and high risk MDS,ten patients achieved complete remission,twenty-two patients achieved partial remission and total efficiency rate was 66.67%,the complete remission rate of decitabine combined with half-dose CAG group was higher than that of decitabine group,the difference is statistically significant(x~2=4.042,P<0.05).There was no significant difference in the total effective rate between the two groups(x~2=0.750,P>0.05).The henogram index were all improved after the treatment of decitabine.the difference is statistically significant(P<0.05).2.Grade III-IV hematological toxicities were observed in overall 48 cases.In the decitabine single drug group,8 cases developed third degree bone marrow suppression and 24 cases developed four degree bone marrow suppression,16 cases of decitabine combined with half dose CAG group were all four degree bone marrow suppression,the difference between the two groups was statistically significant(t=4.800,P<0.05).The duration of decitabine granulocytosis and platelet less than 20was lower than that of decitabine combined with half-dose CAG,and the difference was statistically significant(t=9.076,P=0.000;t=13.805,P=0.000).There was no significant difference in infection,haemorrhage rate,erythrocyte and platelet infusion between the two groups(P>0.05).3.The mean total survival time and average progression-free survival time were(17.3±9.6)months and(9.5±6.7)months in the single decitabine group,higher than(11.2±6.8)months and(5.3±4.2)months in the decitabine combined with half dose CAG group respectively,the difference was statistically significant(t=2.268,P<0.05;t=2.286,P<0.05).Conclusion:1.The total effective rate and remission rate of middle and high risk MDS patients were higher than that of decitabine therapy.The use of preexcitation regimen could improve the complete remission rate of MDS patients.2.After the middle and high risk MDS patients were treated with decitabine based treatment regimen,the number of blood cells in the three lines increased compared with that before treatment,less red blood cell and platelet transfusion,which can reduce the patient’s blood transfusion dependence.3.Decitabine has a unique advantage in prolonging patients’total survival time and transforming time to AML.4.Severe bone marrow suppression in patients with middle and high risk MDS treated with decitabine based regimen,but it is less than the traditional chemotherapy regimen.In the course of treatment,we should strengthen anti-infection,blood transfusion and other symptomatic support treatment.