High Risk Factors Of Patients With Intermediate To High Risk Myelodysplastic Syndrome Transformations Into Acute Myeloid Leukemia Treated By Decitabine

Purpose The article studied the databases of patients with intermediate to high risk myelodysplastic syndrome treated by decitabine-based regiment and explored the high risk factors of transformation into acute myeloid leukemia(AML)in patients with intermediate to high risk myelodysplastic syndrome(MDS)treated by decitabine-based regimenr.The aim is to provide the basis for treatment of patients with myelodysplastic syndrome and control related risk factors to further improve the clinical treatment efficacy.Methods Sixty patients with intermediate to high risk myelodysplastic syndrome treated with decitabine-based regimen at the Qingdao University Affiliated Hospital from 2013 to2018 were selected,including 38 males and 22 females.The clinical characters of intermediate to high risk MDS patients treated by decitabine-based regimen and the high risk factors of transformation into AML in the patients were retrospectively analyzed.The patients’gender,age,2016 WHO MDS diagnostic subgroups,IPSS-R score subgroups,IPSS-R karyotype subgroups,whether the interval of decitabine treatment is prolonged,the interval of decitabine treatment,whether the drug is discontinued before MDS is transformed to AML,the patient’s bone marrow cell morphology,the bone marrow blast cell ratio,immunological typing of bone marrow cells,bone marrow dysplasia coefficient,bone marrow dysplasia category,degree of bone marrow fibrosis,chromosome banding karyotype analysis,blood routine level have been collected.χ~2or Fisher’s exact test is used to analyze the factors affecting overall respond(OR)in the treatment of intermediate to high risk myelodysplastic syndrome with decitabine-based regimen;Kaplan-Meier test univariate factor analysis and COX multivariate analysis are used to analyze the factors of transformation into AML in patients with intermediate to high risk MDS treated by decitabine-based regimen.Results The overall response rate(ORR)of patients with intermediate to high risk MDS treated with decitabine-based regimen was 65.0%(39/60 cases),of which 17 patients(28.3%)achieved complete response(CR);5 patients(8.3%)achieved bone marrow response(mCR);4 patients achieved partial response(PR)(6.7%);13 patients achieved hematologic improvement(HI)(21.7%);21 patients with no response(35.0%).There were 46 cases(76.7%)of overall survival(OS)in 1 year;35 cases(58.3%)of OS in 2years.Sixty patients with intermediate to high risk MDS treated with decitabine-based regimen were transformed into AML in 21 cases(35.0%),including 1 case(4.8%)of MDS-SLD,7 cases(33.3%)of MDS-EB-1,and 11 cases(52.4%)of MDS-EB-2,2cases(9.5%)of MDS-U;median transformation time was 10.0(1.5 months-32.0)months.Theχ~2 or Fisher’s exact test was used to perform a analysis,which showed that 2016WHO MDS diagnostic subgroups,myeloid hyperplasia markedly active,delayed interval of decitabine-based treatment were associated with the transformation from intermediate to high risk MDS into AML(χ~2=9.878,P=0.031;χ~2=4.319,P=0.038;χ~2=6.406,P=0.011);The Kaplan-Meier method was used to perform a univariate analysis,which showed 2016 WHO MDS diagnostic subgroups,bone marrow blast cell ratio,bone marrow dysplasia coefficients,prolonged interval of decitabine-based treatment were associated with the transformation from intermediate to high risk MDS into AML(P=0.015,P=0.008,P=0.012,P=0.032);Results of multivariate analysis by Cox model showed the bone marrow blast cell ratio and the bone marrow dysplasia coefficients were independent risk factors for the transformation from intermediate to high risk MDS into AML(P=0.022,P=0.018).Conclusions The 2016 WHO MDS diagnostic subgroups,the bone marrow blast cell ratio,significantly active bone marrow hyperplasia,bone marrow dysplasia coefficient,and prolonged interval of decitabine regimen are associated with the transformation from intermediate to high risk MDS treated by decitabine-based regimen into AML;The bone marrow blasts cell ratio and the bone marrow dysplasia coefficient are independent risk factors for the transformation from intermediate to high risk MDS treated by decitabine-based regimen into AML.The same interval of dicitabine treatment was beneficial to maintain the disease stability.