Yang Qian, Nie Shu-Min, Li Tian-Lan, Huang Jun-Xia, Liu Shan-Shan, Gao Yan, Yan Xue-Shen, Mao Chun-Xia, Meng Fan-Jun, Feng Xian-Qi
Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China.
Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2020 Apr;28(2):558-566. doi: 10.19746/j.cnki.issn.1009-2137.2020.02.034.
To study the high risk factors for the transformation into acute myeloid leukemia(AML) in patients with intermediate and high risk myelodysplastic syndrome(MDS) treated by decitabine-based regimen.
The clinical characterstics of 60 intermediate and high risk MDS patients and the factors of its transformed into AML were retrospectively analyzed.
The overall response rate(ORR) of the patients suffered from intermediate and high risk MDS treated by decitabine-based regimen was 65.0％(39/60), among the 60 cases 17 achieved complete remission(CR), 5 achieved morrow complete remission(mCR), 4 achieved partial remission(PR) and 13 achieved hematologic improvement(HI). Twenty-one cases(35.0%) were transformed into AML among 60 cases of intermediate and high risk MDS treated by decitabine-based regimen. The median time of transformation from intermediate and high risk MDS into AML was 10.0 months(1.6-32.0). χ or Fisher's exact test showed that 2016 WHO MDS diagnostic subgrouping, myeloid hyperplasia markedly active, delayed interval of decitabine-based treatment associated with the transformation from intermediate to high risk MDS into AML (χ=9.878，P=0.031；χ=4.319，P=0.038；χ=6406，P=0.011); Univariate analysis of Kaplan-Meier test showed that 2016 WHO MDS diagnostic subgroups, bone marrow blast cell ratio, bone marrow dysplasia coefficients, prolonged interval of decitabine-based treatment associated with the transformation from intermediate and high risk MDS into AML (P=0.015，P=0.008，P=0.012，P=0.032); multivariate analysis showed the bone marrow blast cell ratio and the bone marrow dysplasia coefficients were independent risk factors for the transformation from intermediate to high risk MDS into AML (P=0.022，P=0.018).
The bone marrow blast cell ratio and the bone marrow dysplasia coefficients are independent risk factors of transformation into AML in the patients with intermediate and high risk MDS treated by decitabine-based regimen. The regular interval of dicitabine treatment is beneficial to maintain the stability of patients conditions.
研究接受基于地西他滨方案治疗的中高危骨髓增生异常综合征（MDS）患者转化为急性髓系白血病（AML）的高危因素。
回顾性分析60例中高危MDS患者的临床特征及其转化为AML的相关因素。
接受基于地西他滨方案治疗的中高危MDS患者的总缓解率（ORR）为65.0％（39/60），60例患者中17例达到完全缓解（CR），5例达到骨髓完全缓解（mCR），4例达到部分缓解（PR），13例达到血液学改善（HI）。在接受基于地西他滨方案治疗的60例中高危MDS患者中，21例（35.0%）转化为AML。中高危MDS转化为AML的中位时间为10.0个月（1.6 - 32.0）。χ²检验或Fisher精确检验显示，2016版世界卫生组织（WHO）MDS诊断亚组、骨髓增生明显活跃、基于地西他滨治疗的延迟间隔与中高危MDS转化为AML相关（χ² = 9.878，P = 0.031；χ² = 4.319，P = 0.038；χ² = 6.406，P = 0.011）；Kaplan - Meier检验单因素分析显示，2016版WHO MDS诊断亚组、骨髓原始细胞比例、骨髓发育异常系数、基于地西他滨治疗的间隔延长与中高危MDS转化为AML相关（P = 0.015，P = 0.008，P = 0.012，P = 0.032）；多因素分析显示骨髓原始细胞比例和骨髓发育异常系数是中高危MDS转化为AML的独立危险因素（P = 0.022，P = 0.018）。
骨髓原始细胞比例和骨髓发育异常系数是接受基于地西他滨方案治疗的中高危MDS患者转化为AML的独立危险因素。定期进行地西他滨治疗有利于维持患者病情的稳定。
