Clinical observation of decitabine combined with low-dose cytarabine in treatment of high-risk myelodysplastic syndrome / 白血病·淋巴瘤

ABSTRACT

Objective:To observe the clinical efficacy and safety of decitabine combined with low-dose cytarabine in treatment of high-risk myelodysplastic syndrome.Methods:The data of 47 newly treated MDS patients who had high-risk or above scores according to revised international prognostic scoring system (IPSS-R) in the Affiliated Hospital of Qingdao University from January 2016 to September 2018 were retrospectively analyzed. The patients were divided into decitabine combined with low-dose cytarabine group (15 cases) and decitabine group (32 cases). The clinical efficacy and adverse reactions in two groups were compared.Results:After 4 courses of treatment, the bone marrow remission rate, partial remission rate and hematologic remission rate was 20.0% (3/15), 6.7% (1/15), and 13.3% (2/15), respectively in decitabine combined with low-dose cytarabine group, and was 28.1% (9/32), 3.1% (1/32), and 9.4% (3/32), respectively in decitabine group, and there were no statistically differences of both groups (both P > 0.05). The overall response rate in decitabine combined with low-dose cytarabine group was higher than that in decitabine group [93.3% (14/15) vs. 62.5% (20/32), P = 0.037], and the complete remission rate in decitabine combined with low-dose cytarabine group was higher than that in decitabine group [53.3% (8/15) vs. 21.9% (7/32), P = 0.046]. The 1-year overall survival (OS) rate of decitabine combined with low-dose cytarabine group was 86%; and the median OS time of decitabine combined with low-dose cytarabine group was 24 months (95% CI 15.5-32.5 months), which was higher than that of decitabine group (20 months), but there was no statistically significant difference ( χ2 = 0.058, P = 0.810). The incidence of grade Ⅲ-Ⅳ bone marrow suppression and infection in decitabine combined with low-dose cytarabine group was higher than that in decitabine group, but there were no statistically significant differences of both groups (both P > 0.05). Grade Ⅲ-Ⅳ bone marrow suppression and infection were commonly found within the first 2 courses of treatment in decitabine combined with low-dose cytarabine group, and the adverse reactions gradually decreased in the subsequent treatment. Conclusions:Decitabine combined with low-dose cytarabine can achieve better remission rate and prolong survival time for MDS patients with high-risk and above. There is no significant increase in the incidence of grade Ⅲ-Ⅳ bone marrow suppression and infection. For high-risk MDS patients who are not suitable or unable to receive hematopoietic stem cell transplantation, it can be the preferred option.