Therapeutic Research In Decitabine Combined With Priming Regimen For Elderly Patients With Acute Myeloid Leukemia

Objective:To compare the efficacy and safety of decitabine combined with priming regimen and priming regimen single use in newly diagnosed elderly patients with acute myeloid leukemia.Materials and Methods:Using a retrospective analysis,the clinical data of 49 newly diagnosed elderly patients with acute myeloid leukemia(except acute promyelocytic leukemia)from March 2012 to November 2019 in Quanzhou First Hospital were collected.According to the differences of induction chemotherapy regimen,they were divided into two groups,18 patients were treated with decitabine combined with priming regimen(DAC combined with CAG regimen or DAC combined with HAG regimen)and 31 patients received single priming regimen(CAG regimen or HAG regimen).After a course of chemotherapy,we observed and analyzed the efficacy,adverse effects and survival.Results:After a course of chemotherapy,the total CR rate of the DAC+ priming regimen group was 28.58%,in favorable-risk and intermediate-risk of the DAC+ priming regimen group,28.6%(2/7)patients achieved CR,in poor-risk of the DAC+ priming regimen group,33.3%(2/6)patients achieved CR,and the CR rates of the two sub-groups of 60-65 years old and over 65 years old were 28.6%(2/7)and28.6%(2/7).The total CR rate of the control group was 21.74%,in favorable-risk and intermediate-risk of the priming regimen group,44.4%(4/9)patients achieved CR,in poor-risk of the priming regimen group,0(0/6)patients achieved CR,and the CR rates of the two sub-groups of 60-65 years old and over 65 years old were 14.2%(1/7)and25.0%(4/16).The DAC+ priming regimen group and the control group in overall response rates were 64.29% and 47.83% respectively.The median overall survival were respectively 13 months in the DAC+ priming regimen group and 8 months in the control group.There was no statistical significance between the two groups in these results(P>0.05).The difference of non-hematologic adverse reactions in both groups,mainly including pulmonary infection,gastrointestinal reaction,liver and heart dysfunction,were not significant(P>0.05).However,the DAC+ priming regimen group had lower incidence of hematological side effects,the incidence of thrombocytopenia in the DAC+ priming regimen group was lower(P=0.004).What’s more,the average duration time of thrombocytopenia in DAC+ priming regimen group and control group were 2.89(0-10)d and 14.74(2-47)d respectively,the average amount of platelets infusion were 2.17(0-6)therapeutic dose and 3.74(0-10)therapeutic dose respectively,there was significant statistical difference(P<0.05).Conclusion:This study showed that decitabine combined with priming regimen and priming regimen single use have similar therapeutic effects on elderly patients with newly diagnosed acute myeloid leukemia while the decitabine combined with priming regimen shows fewer adverse reactions.In a word,decitabine combined with priming regimen is worth exploring and applying on clinic.