Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China.
Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Blood Cells Mol Dis. 2019 Jul;77:88-94. doi: 10.1016/j.bcmd.2019.03.010. Epub 2019 Mar 31.
Decitabine and low-dose chemotherapy are common treatments for intermediate and high risk myelodysplastic syndromes (MDS). In this study, we retrospectively assessed the efficacy and toxicity of the two regimens for MDS-refractory anemia with excess blasts (MDS-RAEB) patients. A total of 112 patients with a diagnosis of MDS-RAEB are included. The overall response (OR) and complete remission (CR) rate was comparable between the two groups (OR: 64.1% vs. 66.7%, p = 0.60; CR: 23.4% vs. 31.3%, p = 0.64). The OR rates of 20 mg/m/day and 15 mg/m/day decitabine regimen were comparable (69.0% vs. 60.0%, p = 0.46). Overall survival (OS) did not differ significantly between the groups (20.7 vs. 13.5 months, p = 0.17). In a subgroup analysis that included only patients at ≥60 years of age, survival benefit of decitabine was apparent (20.6 vs. 10.0 months, p = 0.03). In hematological toxicities, the lowest count of platelet in the decitabine group was higher significantly. And, the incidence of Grade 3-4 infection in the decitabine group was lower significantly. Our results demonstrate that both decitabine and low-dose chemotherapy are effective for MDS-RAEB, but decitabine was safer. Decitabine might be a better choice for patients at ≥60 years of age.
地西他滨和低剂量化疗是治疗中高危骨髓增生异常综合征（MDS）的常用方法。在这项研究中，我们回顾性评估了这两种方案治疗难治性贫血伴原始细胞增多（MDS-RAEB）患者的疗效和毒性。共纳入 112 例 MDS-RAEB 患者。两组的总反应（OR）和完全缓解（CR）率无显著差异（OR：64.1%比 66.7%，p=0.60；CR：23.4%比 31.3%，p=0.64）。20mg/m/天和 15mg/m/天地西他滨方案的 OR 率相当（69.0%比 60.0%，p=0.46）。两组的总生存（OS）无显著差异（20.7 比 13.5 个月，p=0.17）。在仅包括≥60 岁患者的亚组分析中，地西他滨的生存获益明显（20.6 比 10.0 个月，p=0.03）。在地西他滨组，血液学毒性中血小板最低计数显著更高，而地西他滨组 3-4 级感染的发生率显著更低。我们的研究结果表明，地西他滨和低剂量化疗对 MDS-RAEB 均有效，但地西他滨更安全。对于≥60 岁的患者，地西他滨可能是更好的选择。
