Clinical Observation Of Decitabine Combined With Chemotherapy In The Treatment Of Newly Diagnosed Acute Myeloid Leukemia In The Elderly

Objective:Through retrospective analysis,the efficacy and safety of decitabine(DAC)combined chemotherapy regimen and traditional chemotherapy regimen in newly diagnosed senile acute myeloid leukemia were compared.Methods:From January 2014 to October 2020,the clinical data of 96 newly diagnosed elderly patients with acute myeloid leukemia were collected.58 patients received DAC combined with chemotherapy(27 patients combined with IA/DA;31 patients combined with CAG)and 38 patients received traditional chemotherapy(IA/DA 23 patients,CAG 15 patients).The efficacy,adverse events and survival of the two groups were compared.Results:The overall response rate of DAC group and traditional chemotherapy group were 81.03%and 50%,respectively,with statistical significance(P=0.001).The complete response rates of DAC and traditional chemotherapy groups were 55.56% and 26.32%,respectively,and the differences was statistically significant(P=0.002).The median survival time of DAC group and traditional chemotherapy group was 14 months and 10 months respectively,and the one-year overall survival rate was 40.91% and 30.43% respectively.Kaplan-Meier survival curve was drawn,and there was a significant difference between DAC group and traditional chemotherapy group(P=0.046).It was believed that decitabine combined with chemotherapy could improve the survival rate of elderly AML patients at the same followup time.According to the prognosis stratification according to the patient’s chromosome karyotype,in the prognosis medium karyotype,the overall response rate of DAC group and traditional chemotherapy group were 82.93% and 46.47%,respectively,and the complete remission rates of DAC group and traditional chemotherapy group were 56.1% and 26.67%,respectively.The differences were statistically significant(P< 0.05).According to the chromosome and gene mutation of patients,AML risk stratification was carried out.In the medium prognosis group,the overall response rate of DAC group was higher than that of traditional chemotherapy group,with statistical difference(91.47% vs47.06%,P < 0.05).In the poor prognosis group,the complete remission rate of DAC group was higher than that of traditional chemotherapy group,with statistical difference(58.06%vs 12.50%,P <0.05).The common adverse events in DAC group and traditional chemotherapy group were bone marrow suppression,infection,agranulocytosis fever,and other adverse reactions were mainly gastrointestinal discomfort,drug-induced liver damage,cardiac insufficiency,and hemorrhage.There was no significant difference between the two groups.Conclusion:Compared with IA/DA and CAG,decitabine combined with chemotherapy can improve the remission rate and survival of newly diagnosed acute myeloid leukemia in the elderly.For elderly AML patients with medium karyotype and AML risk of medium and poor prognosis,the combination chemotherapy of decitabine also showed better curative effect.Toxic and side effects are mainly manifested in bone marrow suppression and infection,but they are basically controllable.