| Objectives:To study the clinical effects of low-dose decitabine in combination with CAG regimen in the treatment of elderly patients with myelodysplastic syndrome(MDS).And to research the effect of different treatment schemes on the expression level of soluble CD44(sCD44)、growth factor 11(GDF11),and soluble transferrin ratio in immature red blood cells(sTfR/E).Methods:To collecte clinical data from 45 elderly patients with MDS treated with CAG regimen at our hospital between January 1,2017 and December 31,2021.Patients were divided into a combination group(n=24)versus a CAG group(n=21)based on whether or not they were combined with decitabine.Comparing recent outcomes,blood picture changes,blood transfusion,survival,bone marrow suppression and adverse effects between the two groups.The expression levels of sCD44,GDF11 and sTfR were measured by enzyme-linke immunosorbent assay(ELISA)before and after treatment in both groups.The SPSS 26.0 statistical software was used for analysis.Enumeration data was expressed as parcentages(%)using χ2 test;Measurement data conforming to a normal distribution was indicated as mean ± standard deviation((?))by independent sample t-test;Measurement data that did not conform to a normal distribution was expressed as median using the independent samples non-parametric test;Survival analysis was performed using the Kaplan Meier comparison with the Log-rank test.differences were considered statistically significant at P<0.050.Results:1.The treatment status and overall outcome:The CAG regimen consisted of subcutaneous ara-C(10 mg/m2,q12h,d1-14),intravenous arabinoside(Acla),6 mg/m2,qd,d1-4,and subcutaneous recombinant human granulocyte colony-stimulating factor(G-CSF),200 μg/m2,qd,d1-14,adjusted G-CSF as appropriate according to the patient’s white blood cell or neutrophil count during treatment(reduced or stopped).4 weeks as a course of treatment,to be adjusted according to the patient’s condition.The combination regimen was decitabine 7 mg/(m2·d),qd,d1-5;the CAG regimen was the same as above.Median duration of chemotherapy was 3.5(1-11)sessions in the combination group and 4(1-9)sessions in the CAG group.the complete remission(CR)rate was significantly higher in the combined group than in the CAG group(66.67%vs 28.57%,χ2=6.505,P=0.011),which was statistically significant;the overall remission rate(ORR)was higher in the combined group than in the CAG group(87.50%vs 71.43%,χ2=0.943,P=0.331),which was not statistically significant;median survival time(OS)was better in the combined group than in the CAG group(12 months vs 6 months,P=0.032),which was statistically significant.2.Comparison of changes in haematological indicators between the two groups:before treatment,the differences in leucocytes,haemoglobin and platelets between the two groups were not statistically significant(all P>0.050);after treatment,leucocytes,haemoglobin and platelets in both groups increased to some extent,but higher improvement in the combined group compared to the CAG group and the difference was statistically significant(P=0.011,P=0.049,P=0.033).3.Comparison of blood transfusion independence between the two groups:a total of 38 patients were transfusion dependent at baseline,of whom 20 received the combination regimen and 18 received the CAG regimen(P=0.828),a statistically insignificant difference.After treatment,70.80%of patients in the combined group were no longer transfusion dependent.38.10%of patients in the CAG group were free from blood transfusion dependence,and the difference was statistically significant(P=0.029).4.Incidence of adverse reactions:during the treatment,the incidence of non-hematological toxicity and grade Ⅲ～Ⅳ hematological toxicity was higher in the combined group than in the CAG group,but not statistically significant(P>0.050).5.Comparison of the duration of bone marrow suppression between the two groups:After 1 course of treatment,the duration of granulocyte deficiency and PLT<30 × 109/L in the combined group was shorter than that in the CAG group,and the difference between the two groups was statistically significant(P<0.050)6.The expression levels of sCD44、GDF11、sTfR/E:before the treatment,the expression levels of sCD44,GDF11,sTfR/E between the two groups were not statistically significant(661.79±96.84 vs 648.85±91.72,P=0.649;152.83± 31.49 vs 148.96±30.27,P=0.677;16.31±4.19 vs 16.62±4.25,P=0.812);After 3 courses of treatment,sCD44 and GDF11 decreased in both groups,but the degree of decrease was higher in the combined group than in the CAG group,which was statistically significant(P=0.020,P=0.018).sTfR/E increased in both groups,and the degree of increase was higher in the combined group than in the CAG group,with statistically significant results(P=0.037).Conclusion:1.Compared to CAG alone,low-dose decitabine in combination with CAG could improve the short-term prognosis,achieve greater transfusion independence and prolong survival cycles.2.low dose decitabine combined with CAG regimen reduces the duration of myelosuppression compared to CAG regimen alone and does not significantly increase the toxic side effects,resulting in a good overall safety profile.3.Low-dose decitabine combined with CAG may more significantly downregulate sCD44 and GDF11 levels and increased sTfR/E levels than CAG regime alone,improved hematopoietic function and prognosis of patients... |
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