The Analysis Of Demethylation Treatment And The Application Of Comprehensive Geriatric Assessment In Myelodysplastic Syndrome

Objective: To analyze the clinical characteristics,treatment and survival status of patients with Myelodysplastic syndrome(MDS)and compare the efficacy and safety of demethylation drugs for MDS;Exploring the correlation between the comprehensive geriatric assessment(CGA)and its application in MDS patients.Methods:(1)Collect clinical data from 99 patients with MDS in the Department of Hematology of the First Affiliated Hospital of Jinan University from January 2015 to February 2020,and summarize the patient's age,symptoms,risk stratification,disease progression,mortality,etc.Clinical features.(2)From January 2019,88 patients who survived will be scored by CGA,and the age,sex,IPSS-R,ECOG,treatment method,and CGA score scale will be summarized.(3)The clinical data of 53 MDS patients who received demethylation therapy were collected,and their efficacy and safety were retrospectively analyzed.(4)Statistical method: use spss23.0 for statistical analysis,count data using X2 test,measurement data using Mann-Whitney U test or t test,chi-square test or Fisher test to compare categorical variables,Kaplan-Meier method for survival Analyze and compare the differences by log rank test.P <0.05 is statistically different.Results:(1)Analysis of clinical characteristics,treatment and survival status of MDS patients:(1)General characteristics: a total of 99 MDS cases were collected,with a median age of 69 years old,65 people in the60-79 years old group,accounting for 65.66%;(2)Symptoms and symptoms: dizziness,fatigue Anemia and symptoms such as shortness of breath,fever,etc.are common;(3)Cytogenetics: chromosomal abnormalities were detected in 38 patients,and the detection rate of chromosomal abnormalities was 41.30,of which 17(18.48%)were patients with complex chromosomal abnormalities and non-complex chromosomal abnormalities 21 cases(22.83%);(4)Gene: 38 patients detected at least one gene mutation,the mutation rate was 48.10%,the mutation rate was higher in 8 cases(10.13%)of DNMT3 A,7 cases(8.86%)of TET2,TP536 Cases(7.59%),4 cases of RUNX1(5.06%);(5)According to WHO(2016)MDS classification criteria: 36 cases of MLD(36.36%),the largest number of people;the least proportion is U and RS-SLD,both 1 case(1.01%);(6)treatment method: 53 cases(53.54%)patients received demethylation treatment,accounting for the largest proportion,including 11 cases of AZA treatment and 42 cases of DAC treatment;(7)prognosis stratification: lower risk group: 45 cases of WPSS(48.91%),54 cases of IPSS(58.70%),33 cases of IPSS-R(41.30%),higher risk group: 47 cases of WPSS(51.09%),38 cases of IPSS(41.30%),IPSS-R 59cases(64.13%);(8)Leukemia transformation and death analysis: 11 cases(11.11%)were transformed into acute leukemia,and 18 cases(18.18%)died.The median ages of patients who turned white and died were 72 years and 69.5 years respectively;the median OS was 19(4-32)months and 9.5(0-75)months after diagnosis;the most common cause of death was 11 cases of infectious diseases(61.11%);(9)The median OS of 99 MDS patients was 19(1-122)months,the 2-year OS was(84.7±3.8)%,the 5-year OS was(62.3±14.6)%;the median OS of the demethylation treatment group was(40.78± 2.97)months,median OS(36.11 ± 2.36)months in the non-demethylation group,no statistical difference between the two groups(P=0.582);all chromosomal normal and chromosomal abnormal groups,complex karyotype group and non-complex nucleus Type group,gene mutation group and no gene mutation group,1 gene mutation group and >1 gene mutation group,normal karyotype normal demethylation treatment group and normal karyotype non-demethylation treatment group,karyotype abnormality removal There was no statistical difference in OS and PFS between the methylation group and the non-demethylation group.Patients who received demethylation therapy had normal chromosome and abnormal chromosome groups,complex karyotype group and non-complex karyotype group,gene mutation group and gene mutation-free group,OS of 1 gene mutation group and >1 gene mutation group,There was no statistical difference in PFS.(2)Correlation between the various assessment scales of the comprehensive evaluation of old age and its application:(1)ECOG is negatively correlated with ADL(?=-0.469,P=0.000),negatively correlated with IADL(?=-0.469,P=0.000),and MNA Negative correlation(?=-0.332,P=0.013),positive correlation with TUG(?=0.446,P=0.001),indicating that MDS patients with better physical fitness have stronger self-care ability,better activity ability,and lower fall risk Low;CCI is negatively correlated with MMSE(?=-0.278,P=0.040),MDS patients with comorbidities have poor cognitive function,positively correlated with IADL(?=0.843,P=0.000),and have strong self-care ability in daily life MDS patients have better mobility;IADL is negatively correlated with TUG(?=-0.446,P=0.001),MDS patients with better daily mobility have a lower risk of falling;(2)65 elderly patients in MDS receiving CGA,non-elderly patients In 23 cases,there were statistical differences between the two groups in treatment methods(P=0.004),IADL(P=0.03),CCI(P=0.043),MMSE(P=0.00),TGUG(P=0.013).The median OS in the elderly group was(54.36 ±5.74)months,and the median survival time in the non-elderly group was(67.55±5.60)months.There was no statistical difference in OS between the two groups(P=0.292).(3)Analysis of the treatment of MDS patients:(1)53 patients received demethylation therapy: 11 patients(20.75%)with AZA and 42 patients(79.25%)with DAC;(2)WBC(P=0.017),ANC(P =0.011),PLT(P=0.001),LDH(P=0.001),IPSS-R(P=0.02)were statistically different,WBC and ANC were higher in the DAC group at diagnosis,while LDH and PLT were lower than AZA Group;IPSS-R has a larger proportion of high-risk and very high-risk patients in the DAC group.(3)The incidence of anemia(64.29% vs 54.55%,P=0.035),leukopenia(59.52% vs 45.45%,P=0.51),and thrombocytopenia(73.81 vs 45.45%,P=0.076)in the DAC group were significantly higher than those in the AZA group;(4)There were statistically significant differences in the scores of diseases in the eyes,ears,nose,and throat(P=0.046),kidney(P=0.046),urogenital(P=0.001),and nervous system(P=0.00)in the AZA group and the DAC group;(5)ORR was higher in the DAC group AZA group(54.76% vs 27.27%,P = 0.104);median OS in DAC group was higher than AZA group((41.04±3.21))vs(23.91±2.82)months,P=0.92),median PFS in DAC group was higher AZA group((42.02±3.39)vs(14.14±3.22)months,P=0.011).Conclusions: 1.The median age of onset of MDS patients in this study was 69 years old,accounting for76.77% over 60 years old;the main cause of death was infectious diseases,followed by cerebral hemorrhage;2.The survival rate of MDS patients with old age,physical weakness and cognitive impairment in CGA is poor;3.The incidence of hematological adverse reactions in MDS patients receiving DAC treatment is higher than AZA,while the incidence of non-hematological adverse reactions is lower than AZA.Innovation: At present,there are few reports on the application of CGA to MDS patients at home and abroad.CGA includes the physiological,psychological,and spiritual aspects of patients.CGA is used to compare the survival status of elderly and non-elderly MDS patients,highlighting the need for individualized treatment of MDS patients to facilitate the evaluation of MDS.Patient medical service needs,coordinate health management plan.