ABSTRACT
Objective Decitabine (DAC) combined with the half dose priming regimen (HDPR) is a common treatment of myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) in the elderly. This study was to compare the clinical effect and safety of DAC combined with all-trans retinoic acid (ATRA) versus DAC plus HDPR in the treatment of MDS with excess of blasts (MDS-EB) or AML in elderly patients. Methods We retrospectively analyzed 48 elderly patients (≥60 years) with myeloid neoplasms (AML, MDS-EB-1 or MDS-EB-2) ineligible for standard chemotherapy treated in our hospital from January 2014 to October 2018, 22 by DAC+ATRA (group A) and the other 26 by DAC+HDPR (group B). We compared the overall response rate (ORR), overall survival (OS) and adverse events between the two groups of patients. Results No statistically significant difference was observed between groups A and B in ORR (86.4% vs 76.9%, P = 0.643) or median OS (26.2 vs 24.9 mo, P = 0.920). The median time to response was significantly longer in group A (2 courses) than in B (1 course) (P = 0.006). Compared with group A, group B showed remarkably lower incidence rates of grade-3 to -4 cytopenia (54.5% vs 84.6%, P = 0.029) and infection (45.5% vs 76.9%, P = 0.037), longer duration of neutropenia (P < 0.05), and higher volumes red blood cell infusion and platelet infusion (P < 0.05). There was no statistically significant difference in the incidence rate of bleeding between the two groups (P = 0.643). Conclusion DAC+ATRA and DAC+HDPR have comparable clinical effects on myeloid neoplasms in elderly patients, but the former is safer and better tolerated while the latter can achieve a more rapid response.