| Objective:To find out the treatment situation of elderly patients with AML in the real world in a single center.To compare therapeutic efficacy and safety of the conventional chemotherapy regimen with that of the Decitabine combined with reduced chemotherapy regimen for the treatment of elderly patients with AML.To analyze the prognostic factors of elderly patients with AML.Methods:Retrospectively analyzed the clinical,genetic and molecular biology data of 290 elderly patients with AML(non-APL)who admitted in the Hematology Department of the First Hospital of Jilin University,from May 2009 to May 2016,and all patients were diagnosed by the WHO criteria.Screened the patients who completed one induction therapy with the conventional chemotherapy regimen(including DA,IA,HA,MA,AA,CAG),or the Decitabine combined with reduced chemotherapy regimen(including D-CAG,D-HAG,DCA + DA)(121 cases),and performed bone marrow puncture after therapy at the times of suppression and recovery of bone marrow,then evaluated and analyzed the therapeutic efficacy.A total of 54 patients who achieved CR within 2 courses were included in long-term survival analysis and prognostic analysis.Results:For patients treated with conventional chemotherapy or Decitabine combined with reduced chemotherapy in the first induction therapy.The CR rate was 32.23% within 1 course,while the CR rate was 65.85% within 2 courses.For the conventional chemotherapy group,the CR rate was 29.27%(24/82)within 1 course and 60.71%(34/56)within 2 courses.For the Decitabine combined with reduced chemotherapy group,the CR rate was 38.46%(15/39)within 1 course and 76.92%(20/26)within 2 courses.Compared the patients who achieved CR within 1 course of treatment with those who did not,the percentage of bone marrow primitive cells(P=0.004)and the percentage of peripheral blood primitive cells(P=0.001)were the factors that affected the CR rate.Compared the patients who achieved CR within 2 courses of treatment with those who did not,no factor affecting the CR rate was found(P>0.005).The early mortality rate(within 6 weeks)of the conventional chemotherapy group was 12.20%(10/82),and that of the Decitabine combined with reduced chemotherapy group was 7.69%(3/39),the difference was not statistically significant(P = 0.665).There was no significant difference in adverse reactions between conventional chemotherapy group and Decitabine combined reduced chemotherapy group(P> 0.05).A total of 54 patients who achieved CR within 2 courses,while treated with conventional chemotherapy regimen or Decitabine combined with reduced chemotherapy regimen as the induction therapy,were included in survival analysis.The median follow-up time was 15.0 months(1.3-81.6 months),and the median OS was 18.0 months(95% CI: 15.1-20.9)while the median RFS was 11.0 months(95% CI: 7.9-14.1).1 year OS rate was 62.0%,2 years OS rate was 37.4%.1 year RFS rate was 42.6%,2 years RFS rate was 13.0%.In the conventional chemotherapy group,the median OS was 20 months while the median RFS was 8 months.In the Decitabine combined reduced chemotherapy group,the median OS was 18 months while the median RFS was 14 months.The factors that may affect the prognosis of elderly AML were analyzed,such as age,sex,newly-diagnosed WBC count,ratio of bone marrow primordial cells,ratio of peripheral blood primitive cells,prognosis risk stratification,induction therapy and so on.According to univariate analysis,as for OS,compared to patients with a percentage of bone marrow primitive cells <50%(median OS for 20 months),the OS of patients with a percentage of bone marrow primitive cells of ≥50%(median OS for 11 months)was significantly lower(P=0.003);and compared to patients with a percentage of peripheral blood primitive cells <50%(median OS for 20 months),the OS of patients with a percentage of peripheral blood primitive cells of ≥50%(median OS for 9 months)was significantly lower(P=0.005);besides,compared to patients who received ≥2 courses of consolidate treatment after reaching CR(median OS for 19 months),the OS of patients who only received 1 course of consolidate treatment after reaching CR(median OS for 4 months)was significantly lower(P<0.001);while the other factors on the impact of OS was not statistically significant.As for RFS,compared to patients with a percentage of bone marrow primitive cells <50%(median RFS for 14 months),the RFS of patients with a percentage of bone marrow primitive cells of ≥50%(median RFS for 6 months)was significantly lower(P=0.009);and compared to patients with a percentage of peripheral blood primitive cells <50%(median RFS for 14 months),the RFS of patients with a percentage of peripheral blood primitive cells of ≥50%(median RFS for 5 months)was significantly lower(P=0.009);besides,compared to patients who received ≥2 courses of consolidate treatment after reaching CR(median RFS for 12 months),the RFS of patients who only received 1 course of consolidate treatment after reaching CR(median RFS for 2 months)was significantly lower(P<0.001);moreover,RFS in patients with secondary AML(median RFS for 0 month)was significantly lower than that in primary AML patients(median RFS for 11 months)(P<0.001),while the other factors on the impact of RFS was not statistically significant.According to multivariate analysis,the independent prognostic factors of OS in elderly AML patients were the percentage of bone marrow primitive cells(P=0.030),the percentage of peripheral blood primitive cells(P=0.037),and the number of consolidate treatment course received after reaching CR(P=0.006);the independent prognostic factors of RFS in elderly AML patients were the percentage of peripheral blood primitive cells(P=0.023),and the number of consolidate treatment course received after reaching CR(P=0.001).Conclusions:1.The detection rate of chromosome in this group of patients was 90.13%,among which the detection rate of abnormal clone was 39.80%.With age,the proportion of patients with poor karyotype increased.2.The CR rate of the conventional chemotherapy group was 60.71%,while that of the Decitabine combined with reduced chemotherapy group was 76.92%.As for CR rate,there was no significant difference between these two groups(P>0.05).3.There was no statistical significance in early mortality rate(within 6 weeks)and adverse effects between the conventional chemotherapy group and the Decitabine combined with reduced chemotherapy group(P>0.05)4.A total of 54 patients who achieved CR were included in survival analysis.The median follow-up time was 15.0 months(1.3-81.6 months),and the median OS was 18.0 months(95% CI: 15.1-20.9)while the median RFS was 11.0 months(95% CI: 7.9-14.1).1 year OS rate was 62.0%,2 years OS rate was 37.4%.1 year RFS rate was 42.6%,2 years RFS rate was 13.0%.There was no significant difference in long-term survival between conventional chemotherapy group and the Decitabine combined with reduced chemotherapy group.Multivariate analysis indicated: the independent prognostic factors of OS in elderly AML patients were the percentage of bone marrow primitive cells(P=0.030),the percentage of peripheral blood primitive cells(P=0.037),and the number of treatment course received after reaching CR(P=0.006);the independent prognostic factors of RFS in elderly AML patients were the percentage of peripheral blood primitive cells(P=0.023),and the number of treatment course received after reaching CR(P=0.001). |
