| Objective:To explore the clinical characteristics and molecular biological response of patients with myelodysplastic syndrome to demethylated drugs,and analyze the relevant factors affecting the survival and prognosis,so as to provide a theoretical basis for more personalized risk assessment and treatment response prediction of patients with myelodysplastic syndrome treated with demethylated drugs.Methods:The clinical data of 45 eligible MDS patients admitted to the Hematology Department of Jiangxi Provincial People’s Hospital from December 31,2016 to December 31,2021 were collected retrospectively and divided into two groups according to the efficacy,including 10 patients in the complete remission group and35 patients in the incomplete remission group.There were 30 cases in the effective group and 15 cases in the ineffective group.To analyze the related factors that may affect the curative effect,and to analyze the prognostic factors that may affect the disease progression and survival of patients.Results:1.Treatment response analysis: among the 45 MDS patients who received demethylation treatment,10 patients presented complete remission(CR),and 35 patients did not achieve complete remission(mCR),including 16 patients with complete remission(mCR),4 patients with hematological improvement(HI),and 15 patients with disease progression(PD).The overall response rate(ORR)was 66.7%.With CR as the comparison group,there were no significant differences in blood routine,biochemistry,immunophenotype,gene mutation and IPSS score between the two groups in univariate analysis(P>0.05).Taking ORR as the comparison group,there were significant statistical differences in gender(P=0.033),DNMT3 A or/and TET2 mutation(P=0.01)and IPSS score(P=0.005)between the two groups in univariate analysis.There were significant differences between DNMT3 A or/and TET2 mutations(P=0.045).2.Survival analysis: The median OS of 45 patients was 12(3-52)months,and the median PFS was 8(2-48)months.In univariate analysis,there were statistically significant differences in CD56 expression,chromosome stratification,ASXL1 mutation,ETV6 mutation,TP53 mutation,NRAS mutation,WT1 mutation,IPSS score,IPSS-R score and median PFS in remission(P<0.05).There were statistically significant differences in age,CD7 expression,chromosome stratification,ASXL1 mutation,TP53 mutation,IPSS score,IPSS-R score and median OS in remission(P<0.05).Multivariate analysis showed that the median PFS of chromosome stratification,ASXL1 mutation,TP53 mutation,IPSS stratification and remission were statistically different(P<0.05).There were statistically significant differences in age,CD7 expression,chromosome stratification,ASXL1 mutation,TP53 mutation,IPSS score and median OS in remission(P<0.05).Age was used as a stratification factor: the median OS was 9(3-48)months in the age ≥60 years group,and 14(6-52)months in the age < 60 years group,and there was a statistical difference(P=0.027).The median OS of the CD7 expression group was 7(7-11)months;The median OS of the CD7-free group was 12(3-52)months.The difference was statistically significant(P=0.027).In the ASXL1 mutation group,the median PFS was 4(2-8)months,and the median OS was 8(4-12)months.In the ASXL1 mutant free group,the median PFS was 9(2-48)months and the median OS was 12(3-52)months.There were statistically significant differences in median PFS and median OS between the two groups(P=0.001).TP53 mutation was used as a stratification factor: the median PFS and OS of TP53 mutation group were 4(3-10)months and 7(3-12)months,respectively.The median PFS was 9(2-48)months and the median OS was 12(4-52)months in the TP53-free group.There were statistically significant differences in median PFS and median OS between the two groups(P=0.001).Using chromosomes as stratification factors,the median PFS was 13(2-48)months and the median OS was 16(6-52)months in the good prognosis group.The median PFS was 8(2-36)months and the median OS was 13(4-45)months in the intermediate prognosis group.The median PFS in the good prognosis group was 6(3-10)months and the median OS was 8(3-20)months.There was statistical difference in median PFS among the three groups(P=0.009),and there was statistical difference between the group with poor prognosis and the group with good prognosis after pair comparison(P=0.005).There was statistical difference in median OS among the three groups(P=0.004),and there was statistical difference between the poor prognosis group and the good prognosis group(P=0.002).IPSS score was used as a stratification factor: median PFS was 14(2-48)months and median OS was 14(6-52)months in the MEDIUM-risk 1 group.The median PFS was 6(2-11)months and the median OS was 8(3-20)months in the MEDIUM-risk 2 group.The median PFS in the high-risk group was 4(4-7)months and the median OS was 7(5-14)months.There was a statistical difference in median PFS among the three groups(P=0.000).After pair-wise comparison,there was a statistical difference between the high-risk group and the medium-risk-1 group(P=0.048).There was a statistical difference in median OS among the three groups(P=0.001).After pair-wise comparison,there was a statistical difference between the high-risk group and the medium-risk-1 group(P=0.018).Stratified by disease response,median PFS was 11(7-48)months and median OS was 20(9-52)months in the complete response(CR)group.In the mCR group,the median PFS was 9(5-28)months and the median OS was 12(6-36)months.The median PFS in the haematology improvement(HI)group was 8(3-18)months and the median OS was 10(4-27)months.The median PFS in the disease progression(PD)group was 4(2-8)months and the median OS was 7(3-14)months.There was statistical difference in median PFS between the four groups(P=0.000),and there was statistical difference between the complete remission(CR)group and the progression of disease(PD)group(P=0.000),and between the mCR group and the progression of disease(PD)group(P=0.000).There was statistically significant difference between the improved hematology(HI)group and the disease progression(PD)group(P=0.005).There were statistically significant differences in median OS between the four groups(P=0.000),and statistically significant differences between the complete remission(CR)group and the progressive disease(PD)group(P=0.000),and statistically significant differences between the complete remission(mCR)group and the progressive disease(PD)group(P=0.002).Conclusion:1.DNMT3 A or / and TET2 mutations suggest that MDS patients receiving demethylation therapy are more effective.2.Patients who benefit from demethylation therapy can significantly improve the prognosis.3.Poor chromosome stratification,ASXL1 gene mutation,TP53 gene mutation and higher IPSS score suggest that MDS patients receiving demethylation therapy have short disease progression and overall survival.4.The age ≥ 60 years old and the expression of CD7 suggest that the overall survival time of MDS patients receiving demethylation treatment is short. |
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