Jung Hyun Ae, Maeng Chi Hoon, Kim Moonjin, Kim Sungmin, Jung Chul Won, Jang Jun Ho
Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Hematology-Oncology, Department of Medicine, Hallym University Medical Center, Hallym University College of Medicine, Dontan, Korea.
Oncotarget. 2015 Jun 30;6(18):16653-62. doi: 10.18632/oncotarget.3914.
Despite the efficacy of decitabine to myelodysplastic syndrome (MDS), there is a wide range of responses, and no definite predictive marker has been identified. This study aimed to describe the efficacy of decitabine and to identify potential predictors of response and survival in patients with MDS. We retrospectively analyzed clinical data of MDS patients at Samsung Medical Center between August 2008 and August 2011. The response assessment was conducted using the International Working Group (IWG) response criteria for MDS. We analyzed 101 MDS patients (total 613 cycles) who received decitabine for a median of four cycles. The overall response was 52.5% (n = 53/101). The median time to any response was two cycles with the median overall survival of 16.7 months. Patients who showed hematologic improvement had significantly longer survival than those who did not (9.8 vs. 22.9 months, p = 0.004). The difference in OS was evident in the Intermediate-2/High risk group (p = 0.002) but not in the Intermediate-1 risk group (p = 0.145). Multivariate analysis confirmed that platelet response (no platelet transfusions for at least 3 days) during the second cycle of treatment was an independent predictor for response, OS and Leukemia free survival. Based on the results of this study, for patients with hematological improvement, recovery of platelet count by the second cycle of therapy can be used as an early predictive marker of improved survival and an increased response rate.
尽管地西他滨对骨髓增生异常综合征（MDS）有效，但患者的反应差异很大，且尚未确定明确的预测标志物。本研究旨在描述地西他滨的疗效，并确定MDS患者反应和生存的潜在预测因素。我们回顾性分析了2008年8月至2011年8月三星医疗中心MDS患者的临床资料。采用国际工作组（IWG）的MDS反应标准进行反应评估。我们分析了101例接受地西他滨治疗的MDS患者（共613个周期），中位治疗周期数为4个周期。总体反应率为52.5%（n = 53/101）。出现任何反应的中位时间为2个周期，中位总生存期为16.7个月。血液学改善的患者生存期明显长于未改善的患者（9.8个月对22.9个月，p = 0.004）。总生存期的差异在中危2/高危组中明显（p = 0.002），而在中危1组中不明显（p = 0.145）。多变量分析证实，治疗第二周期时的血小板反应（至少3天无需输注血小板）是反应、总生存期和无白血病生存期的独立预测因素。基于本研究结果，对于血液学改善的患者，治疗第二周期时血小板计数的恢复可作为生存改善和反应率提高的早期预测标志物。
