Clinical Study On Efficacy And Safety Of Decitabine Combined With Reduced-dose Chemotherapy In The Treatment Of Elderly Patients With Newly Diagnosed Acute Myeloid Leukemia

Objective Acute myeloid leukemia(AML)is a heterogeneous hematological malignant clonal disease with a median onset age of 65 years and above,and its incidence gradually increases with age.Now,with the continuous improvement and optimization of chemotherapy regimens,the development of new drugs and the extensive application of hematopoietic stem cell transplantation,the therapeutic effect of the disease gradually improves,and the remission rate increases and the survival time prolongs.However,the long-term efficacy of elderly patients over the age of 60 is still not good,so finding the right treatment for this group of people is especially important.With the development of epigenetics,relevant treatment guidelines recommend different treatment options,such as demethylation drug decitabine combined with low-dose chemotherapy regimen, provides a new way for elderly patients.Therefore,this study will explore the clinical efficacy and safety of decitabine combined with chemotherapy in the treatment of patients with newly diagnosed acute myelogenous leukemia(AML),and evaluate whether this regimen is superior to traditional chemotherapy.Methods We retrospectively analyzed the clinical data of 55 newly diagnosed elderly patients with AML admitted to our hospital from May 2015 to July 2017.Among them,26 patients receiving decitabine combined with reduced-dose chemotherapy regimen(including the joint low-dose idarubicin protocol 17 Cases,joint semi-course CAG regimen in 9 cases);29 cases of traditional chemotherapy regimen(19 cases in IA regimen and 10 cases in CAG regimen).Results(1)Compared with the traditional chemotherapy IA regimen,decitabine combined with low-dose idarubicin had a better overall response rate(OR=82.4%vs47.4%,P=0.041),median survival time vs199 days,P=0.025)and median progression-free survival time PFS(378 days vs185 days,P=0.018)were significantly improved;(2)Compared with the traditional chemotherapy CAG regimen,decitabine combined with half course CAG regimen more effective(OR=77.8%vs20.0%,P= 0.023),median survival time(373 days vs 110 days,P=0.017)and median progression-free survival time PFS(293 days vs 110 days,P=0.029)were significantly improved.(3)COX multivariate analysis indicated that the treatment with decitabine combined with chemotherapy,comorbidity index CCI score 0-1 points,leukocytes<100×10~9/L are prolonged OS,PFS independent prognostic factors.(4)The adverse reactions of decitabine combined with chemotherapy were mainly myelosuppression,infection and so on.The incidence of adverse reactions in each regimen was not statistically significant(P>0.05).Conclusion Decitabine combined with reduced-dose chemotherapy regimen behave better in efficacy of elder patients who were newly diagnosed as AML,and adverse reactions are tolerated and it is worth further research and promotion clinically.