He Pin-Fang, Zhou Jing-Dong, Yao Dong-Ming, Ma Ji-Chun, Wen Xiang-Mei, Zhang Zhi-Hui, Lian Xin-Yue, Xu Zi-Jun, Qian Jun, Lin Jiang
Laboratory Center, Affiliated People's Hospital of Jiangsu University, Zhenjiang 212002, Jiangsu, P.R. China.
The Key Lab of Precision Diagnosis and Treatment of Zhenjiang City, Zhenjiang 212002, Jiangsu, P.R. China.
Oncotarget. 2017 Jun 20;8(25):41498-41507. doi: 10.18632/oncotarget.17241.
Elderly patients with acute myeloid leukemia (AML) have limited treatment options concerned about their overall fitness and potential treatment related mortality. Although a number of clinical trials demonstrated benefits of decitabine treatment in elderly AML patients, the results remains controversial. A meta-analysis was performed to evaluate efficacy and safety of decitabine in treatment of elderly AML patients. Eligible studies were identified from PubMed, Web of Science, Embase and Cochrane Library. Nine published studies were included in the meta-analysis, enrolling 718 elderly AML patients. The efficacy outcomes were complete remission (CR), overall response rate (ORR) and overall survival (OS). Safety was evaluated based on treatment related grades 3-4 adverse events (AEs) and early death (ED) rate. Pooled estimates with 95% confidence interval (CI) for CR, ORR and OS were 27% (95% CI 19%-36%), 37% (95% CI 28%-47%) and 8.09 months (95% CI 5.77-10.41), respectively. The estimated treatment related early death (ED) incidences were within 30-days 7% (95% CI 2%-11%) and 60-days 17% (95% CI 11%-22%), respectively. Thrombocytopenia was the most common grades 3-4 AEs. Subgroup analyses of age, cytogenetics risk, AML type and bone marrow blast percentage showed no significant differences of treatment response to decitabine. In conclusion, decitabine is an effective and well-tolerated therapeutic alternative with acceptable side effects in elderly AML patients.
患有急性髓系白血病（AML）的老年患者，由于担心自身的整体健康状况以及潜在的治疗相关死亡率，其治疗选择有限。尽管多项临床试验证明了地西他滨治疗老年AML患者的益处，但结果仍存在争议。进行了一项荟萃分析，以评估地西他滨治疗老年AML患者的疗效和安全性。从PubMed、科学网、Embase和Cochrane图书馆中识别出符合条件的研究。荟萃分析纳入了9项已发表的研究，共718例老年AML患者。疗效指标包括完全缓解（CR）、总缓解率（ORR）和总生存期（OS）。基于3-4级治疗相关不良事件（AE）和早期死亡（ED）率评估安全性。CR、ORR和OS的合并估计值及95%置信区间（CI）分别为27%（95%CI 19%-36%）、37%（95%CI 28%-47%）和8.09个月（95%CI 5.77-10.41）。估计的治疗相关早期死亡（ED）发生率在30天内为7%（95%CI 2%-11%），60天内为17%（95%CI 11%-22%）。血小板减少是最常见的3-4级AE。年龄、细胞遗传学风险、AML类型和骨髓原始细胞百分比的亚组分析显示，地西他滨治疗反应无显著差异。总之，地西他滨是一种有效且耐受性良好的治疗选择，在老年AML患者中具有可接受的副作用。
