Meta-analysis Of Different Doses Of Decitabine In The Treatment Of Myelodysplastic Syndrome

Background:Myelodysplastic syndrome(Myelodysplastic Syndrome,MDS)is originated from a group of heterogeneous myeloid hematopoietic stem cell clone disease,is characterized by abnormal myeloid cell differentiation and development,performance for the ineffective hematopoiesis,refractory cytopenia,hematopoietic function failure,clinical sees more at old people,disease heterogeneity is strong,natural progression and prognosis of the individual is difference,and it has high risky to turn to acute myeloid leukemia(Acute Myeloid Leukemia,AML),is one of the common blood system of malignant disease.However,demethylated drugs can activate tumor cell tumor suppressor genes and enhance the expression of differentiation genes and other regulatory genes,so they can achieve the purpose of treating MDS.The application of demethylated drugs in the treatment of MDS has been a research hotspot in recent years.The current trend is to limit studies on the reduction of adverse drug reactions on the basis of not affecting the curative effect.In addition,disitamine is a cycles-dependent drug,which can better act on the S phase of cells by reducing the daily dosage and extending the duration of medication.Objective:To evaluate the efficacy and safety of different doses of dexitabine in the treatment of MDS by Meta analysis.Methods:Keywords and free words were combined for retrieval.Databases such as Pubmed,the Cochrane Library,Embase,China National Knowledge Infrastructure,Wanfang database,VIP database were searched.English retrieval words include"decitabine,5-aza-2’-deoxycytidine,5-deoxyazacytidine,Myelodysplastic Syndrommes,Dysmyelopoietic Syndrome,Hematopoetic Myelodysplasias,Dacogen,5-azadc,decitabine Mesylate,NSC-127716,MDS",etc.Chinese retrieval words include"decitabine,myelodysplastic syndrome,Dacogen,Qing Weike,Xin Mei and Kang Dalai",etc.,At the same time to conduct additional retrieval and manual retrieval,back into the literature references and hand-searched part of the grey literature,such as unpublished conference literature and academic thesis,inadequate information on the raw data of the literature by contacting the original author to supplement.According to the inclusion criteria of literatures,eligible literatures were screened and included,and in accordance with Cochrane intervention system evaluation manual and MINORS evaluation scale,the quality of included literatures was comprehensively evaluated and relevant data were extracted.The included literature was evaluated for heterogeneity using I~2,and the potential publication bias was detected by funnel plot.R software was used for meta analysis of single rate.Results:Finally,25 literatures were included,and CR rate,OR rate and other indicators were extracted.R software was used for rate combination,and 3 subgroups were divided according to dose.The results of meta-analysis showed that:(1)the overall CR rate of the 20mg/m~2/d treatment group was higher than that of the45mg/m~2/d(15mg/m~2,q8h)treatment group(21%VS 13%),p<0.001;The overall ORR rate was higher than 45mg/m~2/d(15 mg/m~2,q8h)in the treatment group(57%vs.48%),p<0.001,and the differences were statistically significant.The overall CR rate of the 5-12mg/m~2/d treatment group was higher than that of the 45mg/m~2/d(15mg/m~2,q8h)treatment group(27%VS 13%),p<0.001.The overall ORR rate was higher than45mg/m~2/d(15 mg/m~2,q8h)in the treatment group(65%vs.48%),p<0.001,and the differences were statistically significant.(3)the overall CR rate of the 5-12mg/m~2/d treatment group was higher than that of the 20mg/m~2/d treatment group(27%VS 21%),p=0.065;The overall ORR rate was higher than that of the 20mg/m~2/d treatment group(65%vs.57%),p=0.089,and the difference was not statistically significant.Conclusion:(1)This study showed that for MDS patients,the 5-12mg/m~2/d treatment group and the 20mg/m~2/d treatment group were selected as the priority for individualized treatment according to their specific conditions.(2)The CR rate and ORR rate of the 45mg/m~2/d(15mg/m~2,)treatment group were lower than that of the20mg/m~2/d treatment group and the 5-12mg/m~2/d treatment group.