Clinical Efficacy Of Blood-tonifying Prescription Combined With Hematopoietic Stimulation In The Treatment Of Lower-risk Myelodysplastic Syndrome

ObjectiveTo observe the short-term effect of blood-tonifying prescription combined with hematopoietic stimulation in the treatment of lower-risk myelodysplastic syndrome(MDS),analyze the factors of the curative effect,and explore the superiority of this regimen.MethodsWe collected patients with lower-risk MDS in Guangdong Provincial TCM hospital between January 2011 to January 2019 met criteria for inclusion in this study.All patients were treated with blood-tonifying prescription,hematopoietic stimulation and supportive therapy.We retrospectively analyzed the clinical data,peripheral blood,bone marrow,blood transfusion,TCM symptoms,short-term efficacy,factors of curative effect and survival.Results1.Basic situation:A total of 34 patients with lower-risk MDS,20 were male and 14 were female.The median age was 67 years(range,18?85 years)and median course was 6.5 months(range,0.16?168 months).According to WHO classification criteria,there were 7 RCUD,14 RCMD,4 RARS,7 RAEB1 and 2 were 5q-syndrome.They were classified as IPSS low-risk(7 patients;20.6%),Int-1-risk(25 patients;73.5%)and Int-2-risk(2 patients;5.9%)on initial assessment.For the cohort,29 patients had favorable,2 intermediate and 3 unfavorable cytogenetics based on IPSS criteria-22 patients had multi-lineage dysplasia of bone marrow,and the blast cell counts in 27 patients was less than 5%.The median count of white blood cell,neutrophil,hemoglobin and platelet were 2.83×109/L,1.09×109/L,72 g/L and 74×109/L,respectively.More than 70%of patients had 2?3 line blood cell reduction.Blood transfusion dependence in 22 patients(64.7%).2.Curative effect:According to the Standard of curative effect of TCM,7 patients were significant effective and 19 effective after 24 weeks of treatment,and the overall improvement rate was 76.5%.The symptoms of fatigue,pale or sallow complexion,anorexia were significantly improved(P<0.05).According to the 2006 International Working Group criteria,overall response rate(ORR)was 47.1%,including complete responses(2.9%),hematologic improvements(38.2%),and bone marrow complete responses with hematologic improvements(5.9%).The total effective rate was 64.7%.The hemoglobin count was statistically significant at 4th weeks,8th week and 16th week(P<0.01),and the white blood cell count at 8th week,16th week,24th week were significantly increase(P<0.05);the neutrophils count was similar at each observation point(P>0.05);the platelet count had significance except at 8th week(P<0.05).There was however no significant difference in the bone marrow,including myelodysplastic degree,dysplasis,and blast cell counts(P>0.05),and no improvement in transfusion(P>0.05).3.The factors of the efficacy:Univariate analysis(gender,age,course,complication,WHO classification,dysplasis,myelodysplastic degree,blast cell counts,transfusion,cytopenia coefficient,karyotype prognosis group,IPSS risk grouping and scoring)indicated that other factors had no impact on clinical efficacy except whether there was transfusion dependence.4.Survival:After a median follow-up of 26.7 months,4 patients progressed to the other clinical subtypes,5 patients progressed to leukemia,8 patients died.The average survival was 65.6 months,and the median survival time was not met.The overall survival rate of patients decreased with time.A survival benefit was observed in responders versus nonresponders.Conclusion1.The current results indicated that blood-tonifying prescription combined with hematopoietic stimulation may be a feasible and effective treatment for patients with lower-risk MDS.The treatment improves the count of hemoglobin and white blood cells,but has no obvious effect on platelets.2.The regimen can effectively improve the clinical symptoms,especially good at alleviating the symptoms of qi and blood deficiency such as fatigue,pale or yellow complexion and poor appetite.3.Whether or not blood transfusion dependence can can help to predict the curative effect of the regimen in the treatment of lower-risk MDS.4.A survival benefit was observed in responders versus nonresponders.