Comparison On The Efficacy Of Decitabine And Priming Regimen Single Use And Combination Use Of Them In Older Patients With Acute Myeloid Leukemia

Objective:To compare the clinical efficacy and safety of decitabine(DAC) single-agent regimen,priming regimen,and DAC+priming regimen in the treatment of elderly patients with acute myeloid leukemia(AML).The aim of this study is to explore the optimal regimen for AML to provide a clinical basis for the choice of treatment options for AML patients.Methods:To collect clinical data of 58 elderly patients with AML(excluding acute promyelocytic leukemia) who were treated in the Department of Hematology,First Affiliated Hospital of Bengbu Medical College from June 2010 to December 2017.According to different treatment options,it is divided into DAC single-agent group(DAC 15~20mg/(m~2·d),intravenous drip,d1-3 or d1-5) 20 cases,priming group(CAG regimen or HAG regimen) 18 cases and DAC+priming group(DAC+CAG regimen or DAC+HAG regimen) 20 cases.The efficacy,adverse reactions and survival of the patients in the three groups were observed.Results:1.Comparison of therapeutic effects among the three groups:Among the 20patients in the DAC single-agent group,there were 4 cases of CR(20.0%),4 cases of PR(20.0%),12 cases of NR(60.0%),and 8 cases of ORR(40.0%).Among the 18patients in the priming group,5 patients were CR(27.8%),5 PR(27.8%),8 NR(44.4%),and 10 ORR(55.6%).Among the 20 patients in the DAC+priming group,there were 7 cases of CR(35.0%),9 cases of PR(45.0%),4 cases of NR(20.0%),and 16 cases of ORR(80.0%).The difference of CR rate and PR rate was not statistically significant.The ORR rate of the DAC+priming regimen was higher than that of the DAC single-agent group and the priming regimen group,P=0.035,in which the ORR rate of the DAC+priming regimen group was higher than that of the DAC single-agent group,P=0.010.2.Comparison of the occurrence of adverse reactions in the three groups of treatment regimens:The adverse reactions after treatment in the DAC single-agent group,priming group and DAC+priming group were more common in myelosuppression and pulmonary infection.About 90% of the three groups had III-IV degree of myelosuppression.The median(quartile) description and the non-parametric test were used for the comparison between the groups.It was concluded that the erythrocyte infusion volume of the patients in the three groups after one course of treatment was6.00(2.00,10.00)U,8.00(6.00,12.50)U,and 8.00(2.50,11.50)U,respectively.,P=0.188.The platelet transfusion volume of the three groups after one course of treatment was2.50(1.00,5.75)U,1.00(0.00,2.00)U,and3.00(1.00,5.25)U,respectively,P=0.027.The platelet transfusion volume in the priming group was higher than that in the DAC single-agent group,P=0.032.3.Comparison of survival of the three groups of treatment regimens:Follow-up time was up to February 28,2018.Among the 58 patients enrolled,20 survived,30 died and 8 lost follow-up.The median total survival time of the DAC+priming group was higher than that of the DAC single-agent group,and the comparison between the two groups was tested by Log Rank test,with statistically significant difference(P=0.005).Conclusion:The clinical efficacy of DAC+priming regimen in the treatment of elderly AML patients is better than that of DAC single-agent regimen and priming regimen,with tolerable adverse reactions and relatively long survival time,which is worthy of further clinical research and promotion.