Efficacy And Safety Of Decitabine, CAG And Decitabine Combined With CAG Regimen In The Treatment Of Myelodysplastic Syndromes

【Objective】To compare the efficacy and safety of decitabine,CAG and decitabine combine with CAG regimen in the treatment of myelodysplastic syndromes(MDS).【Methods】Clinical data of 81 diagnosed MDS patients from 2007.03.01 to 2014.09.30 in the Fujian Medical University Union Hospital were retrospectively analyzed. According to patients willing, 36 cases received decitabine regimen, 29 cases received CAG regimen, 16 cases received decitabine combined with CAG regimen. According to follow-up result of each group, the clinical efficacy of three regimens and adverse reactions were analyzed.【Results】The overall response rate(ORR) in the decitabine regimen was 47.2%, including complete remission(CR) in 8 patients(22.2%), hematologic improvement(HI) in 9 patients(25.0%), stable disease(SD) in 12 patients(33.3%).The ORR in the CAG regimen was 37.9%, including CR in 3 patients(10.3%), partial response in 2 patients(6.9%), m CR in 2 patients(6.9%),hematologic improvement(HI) in 4 patients(13.8%), stable disease(SD) in 6 patients(20.7%). The ORR of the decitabine combine with CAG regimen was 56.3%,including CR in 5 patients(31.3%), partial response in 1 patient(6.3%), m CR in 2 patient(12.5%), hematologic improvement(HI)in 1 patient(6.3%), stable disease(SD) in 1 patient(6.3%).ORR difference of Decitabine, CAG and decitabine combine with CAG regimen has no statistical difference(P = 0.483). due to the last follow-up at 2015.03.01, median OS of decitabine regimen, CAG regimen and decitabine combine with CAG regimen were19(2-24) months, 13(0-42) months and 9(0-26) months, the difference of OS in three regimen was statistically significant(P = 0.043), the overall survival(OS) times in decitabine regimen were longer than CAG regimen;median PFS of decitabine regimen, CAG regimen and decitabine combine with CAG regimen were 8(0-21)months, 6(0-25)months and 5(0-17)months, the progression free survival(PFS) in decitabine regimen was longer than CAG regimen and decitabine combine with CAG regimen, although no significant difference was observed(P=0.062).Subgroup analysis showed, patients aged < 60 years who received decitabine regimen demonstrated a better PFS compared with patients who received decitabine combine with CAG regimen(P<0.05);patients aged≥60 years who received decitabine regimen have a longer OS compared with patients who received CAG regimen(P<0.05). the OS、PFS has no significant difference between three groups in the patients of low-risk cytogenetics, the OS 、PFS of patients who received decitabine regimen were significantly longer than that of patients who received CAG regimen in high-risk cytogenetics. The major adverse reactions of three groups during treatment were hematologic toxicity, infections, bleeding, gastrointestinal reactions and fatigue. There were no statistically significant differences(P>0.05) among three groups in terms of duration of neutrophenia, mean red blood cells transfusion, but There were statistically significant differences(P<0.05) among three groups in mean platelet transfusion. The incidences of infection and mortality at 8 weeks in decitabine group were lower than the others.Other adverse events had no difference between the three groups.【Conclusion】Decitabine regimen is an effective therapy in patients with diagnosed MDS. The incidences of treatment related adverse effects is low in Decitabine regimen,most of patients were well tolerated,long-term effect needs further observation.