Clinical Observation Of Descitabine In The Treatment Of Myelodysplastic Syndrome

Objective:To observe the clinical effects and adverse reactions of decitabine(DAC)in the treatment of myelodysplastic syndromes(MDS),for providing reference for rational clinical application of DAC.Methods:The clinical data of 37 intermediate and high-risk MDS hospitalized patients at the Affiliated Hospital of Zunyi Medical University in Zunyi from September 2012 to December 2018 were analyzed retrospectively.According to the treatment regimen,20patients were received DAC at 20mg/m~2·d for 5 days by intravenous drip for 4-week courses of treatment,another 17 patients were treated by traditional chemotherapy regimen.Gender,age,MDS diagnosis period,MDS type,risk stratification,blood routine,liver and kidney function,marrow aspiration smear,marrow biopsy pathology,karyotype analysis,flow cytometry results and survival time were collected and analyzed.The?~2 test was used for count data,and the non-parametric test was used for measurement treatment.By comparing of overall effective rate,survival time and the incidence of hematological toxicity of the two group,the statistical difference was analyzed to investigate the efficacy and safety of the two regimens.Results:1.The overall response rate(ORR)of the DAC group was 55%(11/20),including 15%complete remission(CR)(3/20),15%marrow complete remission(mCR)(3/20),and 25%hematological improvement(HI)(5/20).For the left 9 cases,5 patient's condition didn't exhibit changes and 4 cases failed.The ORR of traditional chemotherapy group was 11.76%(2/17),among which the partial remission(PR)rate was 5.89%(1/17),HI was 5.89%(1/17),4 patient's condition didn't exhibit significant changes and 11 cases failed.The ORR of DAC group was better than that of the traditional chemotherapy group(P<0.05).2.Although the median survival time of the DAC group and the traditional chemotherapy group was 14 months and 9 months respectively,no difference between the two groups was observed(P>0.05).3.Two groups of patients showed different degrees of hematological toxicity,except for 2 cases in DAC group.In the DAC group,the grade III-IV hematological toxicity was65%(13/20)and granulocytopenia was 55%(11/20),including respiratory infections in 11cases and oral gingivitis in 2 cases.Myelosuppression was found in all patients in the traditional chemotherapy group,among which the grade III-IV hematological toxicity accounted for 52.94%(9/17).9 cases(52.94%)were ill with respiratory infection as a result of granulocytopenia.Incidence of hematological toxicity at all levels between the two groups was no difference(P>0.05).Other adverse reactions,including gastrointestinal reactions and systemic rashes,were rare in both groups.4.In DAC gruop,2(10%)progressed to acute myelogenous leukemia after 2 and 4courses of DAC respectively.Conclusion:1.DAC for MDS is more effective than traditional chemotherapy,except of difference in survival time.2.The main adverse effects of DAC are myelosuppression and infections.Therefore,the ideal supportive treatment should include the prevention and treatment of infections.3.DAC-treated cases still endure a high risk of progressing to leukemia,which is worth attention and further observation.