A Short-Term Clinical Efficacy And Adverse Reactions Of The Patients With Myelodysplastic Syndrome And MDS Correlation AML Treated With Ultra Small Dose Of Decitabine

Objective Myelodysplastic syndrome(MDS) is a group of heterogeneous disease,originated in hematopoietic stem cells, the main character is pathological hematopoietic performance, main clinical manifestations is intractable a loss of cells in the system or system,MDS can also have high risk to Acute Leukemia( AL) as its characteristic, especially easy conversion to acute myelogenous Leukemia(AML), we often calls MDS correlation AML. Traditional treatment of MDS including some support treatment,including blood transfusion, granulocyte stimula-ting factor, remove the iron and immunosuppressant, the main goal is to improve symptoms, prevent infection and hemorrhage,the last, improve patient quality of life, the only possible cure is allogeneic hematopoietic stem cell transplantation, but the majority of patients do not meet the prerequisite of transplantation.Epigenetics of in-depth study, decitabine can effectively improve the total effective rate and survival rate of MDS, but the effect of different doses of decitabine are different, the high concentration of decitabine is given priority to cytotoxic effect, the low concentration of decitabine exists demethylation,and after many clinical trials, FDA approved decitabine dosage regimen for treatment of MDS, namely dose for decitabine 20 mg/m2, intravenous for five consecutive days,every 4 weeks again, but it often have three to four hematology toxicity, many patients can not bear such results like infection, hemorrhage. so what is the best doses of decitabine, dosing cycle to get the best curative effect and reduce toxicity of hematology, is stil the majority of the common problems in doctors.This topic chooses MDS and MDS/AML patients as the research object, mainly analyze recent clinical curative effect and adverse event in the different doses of decitabine in the treatment of patients with MDS and MDS/AML, in order to provide a new treatment method and thought in the clinical application.Methods Form september 2013 to september 2015, there were 31 cases of MDS and MDS/AML receiving treatment of decitabine. 5 intermediate-risk MDS patients accept decitabine dose, 15 mg/m2, intravenous drip, five days, 28 days for a course.(short for25 mg qd *5d group). 9 intermediate-risk MDS patients accept decitabine dose,15mg/m2, intravenous drip 3hours, once a week, three weeks a courses( short for 25 mg qw*3w group). 10 intermediate-risk MDS patients accept decitabine dose,7mg/m2,intravenous drip 3hours, once a week, three weeks a courses.(short for 10 mg qw*3w group).5 intermediate-risk MDS cases and 2 cases of MDS/AML patients, decitabine dose, 15 mg/m2, intravenous drip, 3hours, once a week, three weeks a course,at the same time, 5 cases of intermediate-risk group MDS patients combined the CAG scheme,2 cases of MDS/AML patients combined HAG scheme.Statistical analysis by SPSS17.0 statistical software to a = 0.05 for the inspection level, analysis and comparison between intermediate-risk MDS patients in each group of recent clinical curative effect and adverse reaction of hematology, and intermediate-risk MDS and MDS/AML recent clinical curative effect in patients with hematologic adverse reactions.Results 25 mg qd * 5 d group : 2 cases at the end of the first period of treatment is marrow partial reponse but not associated with hematological improve, 3 progression disease, bone marrow suppression after discontinuation of the heaviest for 3-20 days,recovery period for 30 to 40 days after drug with decitabine, four patients are III’-IV’dropping blood, lung infection in the bone marrow suppression in 4 patients, including 1case of patients with skin soft tissue infection at the same time. 25 mg qw*3w and 10 mg qw*3w groups, a total of 19 patients with MDS, number average period of treatment is 2.2, the results show, 1 case CR, 7 cases HI, 11 cases SD, the total effective rate was 42%. Compare two groups,, hemoglobin levels before and after treatment was statistically significant(p < 0.05). platelets, red blood cell transfusion, blood loss and infection had statistical significance(p < 0.05). 25 mg qw*3w combination chemotherapy group: 5 cases of MDS patients,2cases m CR with HI, 1 case of PD, 2cases were lost to follow-up; 2 cases of MDS/AML patients, respectively get CR after treatment of decitabine, during the period of combination chemotherapy, 7 patients occurred IV ’level dropping blood, infection rate was 100%.Conclusion Total effective rate of MDS patients treated with ultra dose of decitabine is similar with the current recommended decitabine dosage regimen, and at the same time greatly reduce the decitabine hematologic adverse reactions, infection risk and the dependence on blood transfusion, significantly improve the survival quality of patients,it can be further promotion in clinical on account of the low rate of infection and hematological toxicities.