| BackgroundMyelodysplastic syndrome (MDS) is one of the most common hematologic malignancies. Numerous factors are related to the development of MDS and can be divided into two big classifications:original and secondary. Original factors include epigenetic changes, abnormalities in cytokines, immune systems, and bone marrow stroma. Secondary factors include chemotherapy, radiotherapy, smoking, and occupational exposure to agriculture chemicals. The incidence rate of MDS is very low in people under 50 years of age, while most of MDS happen in the seniles and reaches 20/100,000 in the age group above 70 years. MDS has a propensity to occur on male with a male to female ratio of 1.8:1.The classification of MDS has experienced several changes in the history. In 1982, French-American-British cooperative group published a seminal classification system of MDS and divided it into five subtypes:refractory anemia, refractory anemia with ring sideroblasts (RARS), refractory anemia with excess of blasts (RAEB), RAEB "in transformation" (RAEB-T), and chronic myelomonocytic leukemia (CMML). In 2008, World Health Organization modified this classification and divided MDS into six subtypes. Now, the modified 2008 classification is the universal standard used to diagnose MDS worldwide.According to the percentage of blasts in the patient’s bone marrow, the results of cytogenetic tests and hematopoietic lines affected by the disease, International Prognostic Scoring System (IPSS) classifies MDS patients into low-risk, intermediate-risk (including intermediate-1 risk and intermediate-2 risk) and high-risk three big groups. This has been the standard index for evaluating the prognosis of MDS patients worldwide.PurposeThe purpose of this research was to systematically evaluate patients based on the standards by using the test results obtained after the admission. Final diagnosis of the patients were made according to the 2008 WHO Classification. Meanwhile, further evaluated the patients’prognosis according to IPSS.Materials and methodsSeveral MDS patients were selected from all patients admitted to Hematology Department of Zhongshan Hospital affiliated to Fudan University. They were then thoroughly evaluated and classified according to WHO 2008 Classification and the prognostic scores were calculated according to IPSS.ResultsA total of 23 patients were selected. Among them,12 were female and 11 were male. Age range was from 14-year-old to 74-year-old, with 10 above 60-year-old. The average age of these 23 patients was 52.65-year-old and the median was 53-year-old.8 people were diagnosed as MDS RAEB-1,13 were diagnosed as MDS RAEB-2,1 was diagnosed as MDS RCMD,1 was diagnosed as MDS with del (5q).6 patients were IPSS intermediate-1 risk,8 were intermediate-2 risk and 4 were high-risk (patients with incomplete data were excluded).ConclusionThe average age of these 23 patients were 52.65-year-old, around the peak incidence age of 50-year-old as reported by the papers. The male to female incidence ratio was 11:12, opposite to the concept that male has a higher MDS incidence rate than female.BackgroundDifferent treatments are selected for MDS patients with different IPSS classification. Patients with low-risk can be followed-up for quite a long time without any treatment while patients with intermediate-risk and high-risk can benefit from treatment. Allogeneic stem cell transplantation is the only method for long-term remission, but not suitable for all the patients. Supportive care is still the mainstream care for MDS patients worldwide. At the same time, various kinds of treatments are under investigation, including angiogenesis inhibitors, Farnesyl Transferase Inhibitors, and DNMTi. FDA has approved the use of DNMTi for the clinical treatment of MDS, including higher risk MDS patients and lower risk MDS patients who are non-responsive to growth factor therapy or who are HLA-DR15 negative. At the same time, being a type of epigenetic modification drug, DNMTi has been recognized more and more widely by people.In 2000, IWG put forward a standardized criteria for evaluating the reaction of MDS to the treatment, including the improvement of the natural history of the disease, hematologic improvement, cytogenetic reaction and improvement of health-related quality of life.PurposeThe purpose of this research is to evaluate the effect of DNMTi on the treatment of MDS patients by using IWG standard.Materials and methodsAmong all the patients admitted to Hematology Department of Zhongshan Hospital affiliated to Fudan University, those diagnosed with MDS were selected. They were then divided into treatment group and control group. Patients in the former group all received treatment of DAC while patients in the latter group received all other treatments. Details of using Decitabine were analyzed for every patient, including drug doses, administration methods, treatment courses, etc. Finally, the effect of Decitabine was evaluated by IWG standard.ResultsSeven patients from treatment group were analyzed for the efficacy of Decitabine in the treatment of MDS patients. The mean follow-up timeframe was 45w; average time for chemotherapy was 4.6; response rate including CR and PR reached 57.14%; the mean time to first response was 13.75w. There was a significant difference on response rate between treatment group and control group.ConclusionThe overall response rate of the seven patients reached 57.14%, higher than 26%-45% as reported by reviews. This result proves that decitabine does have some effect on treating MDS. However, due to the small amount of subjects in this experiment, the result can not be considered as a strong evidence for high response rate of decitabine in the treatment of MDS. |
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