| [Objective]:To therapeutic the value of low-dose decitabine in patients with intermediate-risk-2 or high-risk MDS with an ECOG score of>2-?3[Background]:At present,there is no clear treatment plan for elderly patients with MDS.With the development of epigenetics,demethylation drugs have gradually become the first-line treatment for patients with MDS,but the standard dose of decitabine produces heavier myelosuppression.Patients with ECOG scores of 2-3 are poorly tolerated,and most patients cannot adhere to complete treatment and affect the treatment effect.We therefore attempted to take a reduced dose of decitabine to study the efficacy and adverse effects of patients with ECOG scores of>2-?3.[Methods]:From January 2000 to December 1919,a total of 41 cases of myelodysplastic syndrome with an IPSS-R score of?3.5 or an IPSS-R score of<3.5,but with severe blood transfusion dependence and an ECOG score of 2 or higher(MDS patients were enrolled in the study,including 28 males and 16 females,aged 50-82 years(median=67 years).Patients were grouped by ECOG score.Group A:ECOG score?2-<3 points.Standard dose of decitabine(DAC);25mg/m2*5-7d,9 cases,6 males and 3 females;Group B:ECOG?3 patients with low dose DAC:lOmg qod*5-7d,a total of 16 cases,12 males and 4 females;group C:ECOG>3 points,and patients with age?75 years of age choose Best Support Cares(BSCs):blood transfusion,stimulation of hematopoiesis,sputum iron treatment.A total of 16 cases,including 10 males and 6 females.All patients underwent 185 treatments,including 133 times?3 times.The efficacy and adverse reactions between the three groups were compared to further evaluate the clinical value of low-dose decitabine in such patients.[Results]:Basic situation:9 patients in group A,6 males and 3 females;7 in middle-risk-?,1 in high-risk,1 in very high-risk;5 in MDS-EBI,2 in.MDS-EB?,2 in MDS-MLD.16 patients in group B,12 males and 4 females,8 in middle-risk-?,6 in high-risk,2 in very high-risk,4 in MDS-EBI,4 in MDS-EB?,6 in MDS-MLD,1 in MDS-RAS and 1 in MDS-SLD;16 patients in group C,10 males and 6 females,14 in intermediate risk-?,1 in high risk,1 in high risk;3 in MDS-EB?,3 in MDS-EB?,8 in MDS-MLD,1 in MDS-RAS,1 in MDS-SLD.Comparison of efficacy evaluate between groups:Group A:There were 9 cases(100%)completed 1 course,ORR was 78%:(7/9),of which CR cases were 4 cases(45%),PR cases were 2 cases(22%),and HI cases were 1 case(11%),NR cases were 2(22%);8 cases(89%)completed 3 courses,ORR was:88%(7/8),of which CR cases were 4 cases(50%),PR cases were 2 cases(25%),HI cases was 1 case(13%),NR cases was 1 case(12%);5 cases(56%)were completed for 5 courses,ORR was:80%(4/5),of which CR cases were 2 cases(40%),PR cases were 2 cases(40%),HI cases were 0 case,and NR cases was 1 case(20%);There were 3 patients(33%)completed 5 courses of treatment,ORR:100%(3/3),of which CR cases were 2 cases(67%)and HI cases was 1 case(33%);Group B:There were 16 patients(100%)completed 1 course of treatment,ORR was:75%(12/16),of which CR cases were 3 cases(19%),PR cases were 2 cases(13%),and HI cases were 4 cases(25%)and NR cases were 7 cases(44%);15 cases(100%)completed 3 courses,ORR was:100%(15/15),of which CR cases were 2 cases(13%),PR cases were 3 cases(20%),HI cases were 10 cases(67%),NR cases were 0 case;13 cases(87%)completed 5 courses,ORR:92%(12/13),of which CR cases were 3 cases(23%),PR cases was 1 case(8%),HI cases were 8 cases(62%).and NR cases was 1 case(8%);There were 6 patients(40%)with 5 courses of treatment.ORR was 100%(6/6),of which CR cases were 2 cases(33%);HI cases were 4 cases(67%);Group C:There were 16 cases(100%)completed one course of treatment,8 cases(50%)completed 3 courses of treatment,4 cases(25%)completed 5 courses of treatment,and 3 cases(19%)completed 5 courses.After 1 course of treatment,5 patients were discharged automatically.Among them,2 patients with organ bleeding(1 cerebral hemorrhage,1 gastrointestinal bleeding)and 3 patients with poor infection control were all pulmonary infections;3 cases The patient gave up treatment for progression to acute leukemia.After 3 courses,3 patients gave up treatment due to progression to acute leukemia,1 patient gave up treatment due to financial difficulties,and 1 patient was discharged automatically due to acute left heart failure.One patient died of severe pulmonary infection after 5 courses of treatment.Adverse reactions between groups:In group A and group B,the incidence of grade I adverse reactions was:45%(n=19)vs 62%(n=51);the incidence of grade ? adverse reactions was:19%(n=8)vs 23%(n=19);the incidence of grade ? adverse reactions was:29%(n=12)vs 15%(n=12);the incidence of grade IV adverse reactions was 7%(n=3)vs 0%(n?0);P?0.02(<0.05).[Conclusion]:It can be seen that although the low-dose decitabine has a lower CR rate,But the ORR rate is almost the same as the standard dose;and the survival time of patients with BSCs is significantly prolonged,the risk of severe infection and bleeding is significantly reduced;the adverse reactions are mild,and the patient's tolerance is good.Therefore,for patients with an ECOG score of>2-?3,low-dose decitabine can also be used as a treatment choice... |
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