| Objective: To compare the clinical efficiency and the rate of toxic and side effects of Decitabine combined with low-intensity chemotherapy regimen and standard chemotherapy regimen in elderly patients with Acute Myeloid Leukemia.Methods:We retrospectively studied a total number of 120 elderly patients with Acute Myeloid Leukemia enrolled from hematology department of the Second Hospital of Hebei Medical University from January 2014 to October 2019.The patients were divided into two groups by induction regimens,including 61 cases of DAC+low-intensity chemotherapy regimen and 59 cases of standard chemotherapy regimen.Comparison of the complete remission rate of DAC+low-intensity chemotherapy regimen and standard chemotherapy regimen.Comparison of the CR rates of DAC+low-intensity chemotherapy regimen and standard regimen in patients >65 years old or ≤65 years old.Comparison of the OS between two regimens and each layer of risk defined by age and PS score.Comparison of the CR rates influenced by different adverse cytogenetics and the differences of hematological toxicity,infection,compromise of hepatic and renal functions,mucositis,gastrointestinal reaction,bleeding,et al.Results:1.The CR rate of DAC+low-intensity chemotherapy regimen(62.3%)is lower than that of standard chemotherapy regimen(79.7%)with an obviously statistical significance(P<0.05).2.In 37 patients above 65 years old,the CR rate among 26 cases with DAC+low-intensity chemotherapy regimen(65.4%)and 11 cases with standard chemotherapy regimen(72.7%)showed no statistical significance(P>0.05).In 83 patients under 65 years old,the CR rate of standard chemotherapy regimen(81.3%)is higher than that of DAC+low-intensity chemotherapy regimen(60.0%)with a statistical significance(P<0.05).3.Up to follow-up date,there were only two patients survival,49 cases demised and 10 loss in DAC+low-intensity chemotherapy regimen group,with 9 months median OS,one year survival rate of 32.1% and two year survival rate of 2.3%.There were only 6 patients survival,41 cases demised and 12 loss in standard chemotherapy regimen,with 9 months median OS,one year survival rate of 39.9% and two year survival rate of 13.9%.The differences of the median OS between the two groups have no statistical significance(P<0.05).Among the patient>65 years old,the median OS was 5 months,one year survival rate was 18.5% and two year survival rate was 0 in DAC+low-intensity chemotherapy regimen group.While the median OS was 5 months,one year survival rate was 9.1% and two year survival rate was 0 in standard chemotherapy regimen group,showing no statistical significance(P>0.05).Among the patient≤65 years old,the median OS was 10 months,one year survival rate was 42.2% and two year survival rate was 4.2% in DAC+low-intensity chemotherapy regimen group.While the median OS was 12 months,one year survival rate was 44.9% and two year survival rate was 21.6% in standard chemotherapy regimen group,showing no statistical significance(P>0.05).In patient who’s PS score≥2,the median OS was 8 months,one year survival rate was 28.6% and two year survival rate was 3.6% in DAC+low-intensity chemotherapy regimen group.While the median OS was 7 months,one year survival rate was 19.2% and two year survival rate was 2.4% in standard chemotherapy regimen group,showing no statistical significance(P>0.05).4.In DAC+low-intensity chemotherapy regimen group,the CR rate of patients with FLT3-ITD gene(81.8%)is higher than that of patients without the gene(41.7%),showing a statistical significance(P<0.05).The CR rate of high risk patients with FLT3-ITD gene is higher than those without in DAC regimen.5.Compared to DAC regimen,standard chemotherapy presented a higher risk of hematological toxicity and infection with a statistical significance(P<0.05),while other side effects show none(P>0.05).Conclusions:1.For elderly patients under 65 years old who are newly diagnosed as AML,the superior induction regimen would be standard chemotherapy that achieves a higher CR rate.For those above 65 years old,the DAC regimen have the similar effect with the standard chemotherapy.2.When a variety of basic diseases and dysfunction of viscera exist,the overall survival time of DAC+low-intensity chemotherapy regimen was the same as that of the standard regimen with less toxic and side effects.3.For elderly patients newly diagnosed as AML with FLT3-ITD gene positive,DAC+low-intensity chemotherapy regimen would be a better choice.4.The toxic and side effects mainly present myelosuppression and infection,the incidence of toxic and side effects of the standard regimen was higher than that of DAC+low-intensity chemotherapy regimen. |
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