| Background Acute myelogenous leukemia(AML)is a hematological malignancy,and it is the most common type of adult acute leukemia.At present,the commonly used clinical treatment of AML includes traditional chemotherapy,bone marrow transplantation and the use of new drugs.However,the overall cure rate of traditional chemotherapy is not iedal,and the adverse reactions and side effects are large.The recurrence rate of pre-stimulation regimen with reduced dose is high,and the use of bone marrow transplantation and new drugs is limited to a certain extent.Therefore,it is necessary to explore a more economical,effective and safer treatment plan.Objective To investigate the effect of decitabine combined with HAG chemotherapy in patients with acute myeloid leukemia(AML)and the effect of this regimen on the early T lymphocyte subsets in these patients.Methods 128 patients were selected and randomly divided into observation group(64 patients)and control group(64 patients),who were with AML and received chemotherapy in our hospital from January 2019 to August 2021.The patients in the observeation group were treated with decitabine combined with HAG chemotherapy regimen(Harhartonine 1mg/day D1-8+cytoximab 50mg/day D1-14+recombinant human granulocyte colony-stimulating factor 150μg/day D0-14).During the trial,patients were given intravenous infusion of decitabine once a day(jiangsu Hausen,H20130067).The drug was administered intravenously with a daily dose of 15mg/m~2/day.After three consecutive days of use,the patient were given HAG regimen for chemotherapy for 14days.Control group using conventional pre-excitation syndrome plan CAG chemotherapy,during the study period,1times a day,for eight consecutive days to give patients injections in acranomycin 10mg/time once a day for 8 consecutive days.Cytarabine and recombinant human granulocyte colony-stimulating factor for injection were the same as those of the observation group in terms of batch manufacturer,dose and use.The observation group and the control group were treated for28 days.After treatment,the remission rate of patients in the observation group and control group,the incidence of recurrence of the disease 12months later,the adverse reactions during the treatment and the toxic and side effects after the treatment were compared,and the changes of T lymphocyte subsets and cytokines in the two groups were compared between the observation group and the control group after chemoterapy.Results(1)From the two groups of patients,comparing the clinical curative effect of observation group remission rate reached 93.75%,far higher than the control group60.93%response rate(x~2=19.661,P<0.05),in the observation group,complete remission in 48 cases,partial in 12 cases,control group complete response in 12 cases,partial in 27 cases,the experimental results show that using decitabine and HAG combination in the observation group has been done on the treatment of AML more prominent clinical curative effect.(2)Compared with the control group before treatment,after treatment,CD3~+was(60.59±4.96)%,CD4~+was(30.09±3.19)%,CD8~+was(42.33±4.21)%,CD4~+/CD8~+was(1.15±0.92)%in the control group presented significant statistical changes(P<0.05).After treatment,the values of CD3~+,CD4~+,CD4~+/CD8~+in the observation group presented a significant increasing trend,and CD8~+showed a decreasing trend.(P<0.05),indicating that the drug combination regimen for AML patients in the observation group can improve the serum level of T lymphocyte subsets to a certain extent,while the regimen for the control group also has an improvement effect.Comparison between the two groups,before the treatment,control group and observation group in the two groups of CD3~+,CD4~+,CD8~+,CD4~+/CD8~+were no significant difference(P>0.05),and further comparing the data of two groups after treatment,the observation group in CD3~+,CD4~+,CD4~+/CD8~+value are obvious rise,CD8~+values appear more significantly reduce the trend,(P<0.05),and compared with the control group,the difference is more significant,comprehensive prompt joint solutions in the process of AML treatment,can significantly improve the patient’s immune function.We further analyzed the changes of CD3~+,CD4~+,CD8~+,and CD4~+/CD8~+in different remission conditions of the patients after chemotherapy.In terms of patients with complete remission,the CD3~+(72.98±3.64)%,CD4~+(45.13±4.16)%,CD4~+/CD8~+(1.41±0.14)%in the observation group were significantly higher than those in the control group,while the CD8~+(29.13±3.74)%were significantly lower than those in the control group(T=3.915,4.522,3.300,1.065,P<0.05).Under the condition of PR,27 patients in the control group and 4 patients in the observation group showed that the expression of CD4~+(67.12±4.54)%,CD4~+(38.47±4.33)%and CD4~+/CD8~+(1.42±0.12)%in the observation group were all higher than those in the control group,while the expression of CD8~+(34.44±5.12)%was significantly lower than that in the control group(T<2.472,5.576,3.014/0.969,P<0.05).In NC patients,there were only 4 patients in the observation group and 25 patients in the control group.There was a significant difference between the two groups(P<0.05).In this case,there was no statistical difference in the data of CD3~+,CD4~+,CD8~+and CD4~+/CD8~+between the two groups(T=0.448,0.228,0.239,0.020,P>0.05).According to the above experimental results,the combination of decitabine and HAG in the treatment of AML has a positive effect on the remission of the disease in patients.(3)The cytokines levels of IL-2,IL-4,IL-10 and IFN-γin the two groups were compared before and after chemotherapy:Compared with the group before treatment,we found that the levels of IL-2 and IFN--γin the two groups after chemotherapy increased to a certain extent,IL-4 and IL-10 showed a downward trend(P<0.05).Further comparison between the two groups showed that before chemotherapy,there was no significant difference in the indicators of IL-2,IFN--γ,Il-4 and Il-10 between the two groups(P>0.05).After chemotherapy,the indicators of IL-2(28.69±2.34)pg/ml and IFN--γ(40.12±3.67)pg/ml in the observation group were significantly higher than those in the control group(T=13.817,9.262,P<0.05).Il-4(29.34±4.58)pg/ml and IL-10(19.21±3.91)pg/ml were lower than those of the control group(T=13.499,22.155,P<0.05),indicating that the combination of Decitabine and HAG can effectively improve cytokines in AML patients,and its improvement effect is significantly better than the control group.(4)In the observation group,thrombocytopenia accounted for 6.25%,nausea and vomiting accounted for 9.38%,fatigue accounted for 14.06%,constipation accounted for4.59%,and respiratory infection accounted for 17.18%.After chemotherapy,fatigue accounted for a large proportion of the patients,and 33 patients in the observation group produced major adverse reactions.In the control group,thrombocytopenia accounted for15.63%,nausea and vomiting accounted for 12.5%,fatigue accounted for 15.63%,constipation accounted for 6.25%,and respiratory infection accounted for 25%,among which respiratory infection accounted for a large proportion and the number of people with major adverse reactions was 48.The number of major adverse reactions caused by chemotherapy in the observation group was less than that in the control group(P>0.05),and the thrombocytopenia in the observation group was 6.25%significantly lower than that in the control group(P>0.05).(5)The total complication rate of the control group was 92.19%,including 30 patients with elevated transaminase,and the postoperative complication rate of the observation group was 76.56%.Further comparison between the groups showed that the postoperative complication rate of the observation group was significantly lower than that of the control group(2=0.321,P=0.571).(6)Two groups of patients after drug treatment,WBC decline,the control group and observation group at 0,Ⅰ,Ⅱperiod without obvious difference(P>0.05)in particular,Ⅲleukocyte reduction period,observation group 2 cases,significantly less than the control group(chi-square=6.935,P=0.05).(7)there was no significant difference in gastrointestinal reactions between the observation group and the control group(P>0.05).There were 38 patients in the observation group at stage 0,which was higher than that of the control group,but the difference was not statistically significant(P>0.05).In terms of liver and kidney injury,there was no significant difference between the control group and the observation group(P>0.05).(7)After 12 months of follow-up investigation on the two groups after chemotherapy,the cumulative recurrence rate of the observation group was lower than that of the control group,and the recurrence rate of the observation group tended to be stable after 8 months.Survival was investigated and analyzed for 12 months after chemotherapy in the two groups,and the survival rate of the observation group was higher than that of the control group,proving that combined chemotherapy with decitabine and HAG could improve the survival of patients with AML.Conclusion Decitabine combined with HAG chemotherapy regimens is significantly effective compared with CAG pre-excitation regimen alone,and does not increase adverse reactions and side effects,it is with good safety.After treatment with the combined regimen,the subsets of T lymphocytes and regulatory factors of cellular immunity in patients were improved to a certain extent,which is conductive to the immune system of the body to resist tumor cells,effectively inhibit their immune escape,and control the disease progression of AML to a certain extent. |
PDF Full Text Request