地西他滨治疗后28 d的淋巴细胞预测骨髓增生异常综合征患者的治疗反应

Predicting Therapeutic Response by Lymphocyte Level at 28th Day after DAC Treatment in Patients with MDS

目的:探索能够早期预测地西他滨(DAC)在骨髓增生异常综合征(MDS)中治疗反应的临床指标。方法:对55例MDS患者DAC治疗效果进行回顾性分析,根据患者DAC首次治疗后28天的淋巴细胞水平将患者分为高淋巴细胞组(H-Lym≥1. 2×109/L)和低淋巴细胞组(L-Lym <1. 2×109/L),比较两组的总反应率(ORR)、无进展生存期(PFS)之间的差异。结果:55例患者中,H-Lym组ORR为76. 0%,L-Lym组ORR为50. 0%,二者之间统计学差异显著(P <0. 05); H-Lym组中血小板≥100×109/L比例非常显著高于L-Lym组(72. 0%vs 20. 0%)(P<0. 01)。H-Lym组患者的中位PFS时间15. 7个月,L-Lym组的中位PFS 8. 5个月,二者之间统计学差异显著(P<0. 05),L-Lym组患者疾病进展的风险非常显著高于H-Lym组,为H-Lym组的4. 45 (95%CI:1. 58-12. 59)(P<0. 01)。结论:DAC首次治疗后28 d淋巴细胞≥1. 2×109/L的患者具有较高的总反应率和较长的无进展生存期,可作为预测地西他滨治疗反应的早期临床指标。

Objective: To investigate a reliable clinical indication for predicting the therapeutic response of decitabine therapy in the patients with myelodysplastic syndromes ( MDS) .Methods: The clinical efficacy of decitabine for 55 cases of MDS was analyzed retrospectively.According to the lymphocyte level at d28 after the first time treatment with decitabine,the patients were divided into high lymphocyte level group ( H - Lym≥1.2 × 10^9 /L) and low lymphocyte level group ( L-Lym <1.2 × 10^9 /L) ,and the overall response rate ( ORR) and the progression - free survival ( PFS)time in 2 groups were compared.Results: As compared with L - Lym group,the ORR and PFS time in H - Lym group were significantly enhanced [( 76.0% vs 50.0%) ( P<0.05) and median time ( 15.7 months vs 8.5 months) ( P<0.05) ,respectively]; the ratio of platelet level ≥100 × 10^9 /L in H - Lym group was very significantly higher than that in L - Lym group ( 72.0% vs 20.0%) ( P<0.01) .Multivariat analysis showed that the risk of disease progression in L - Lym group was 4.45 - fold of H - Lym group ( 95% CI: 1.58 - 12.59) ( P<0.05) .Conclusion: The patients with lymphocyte level ≥1.2 × 10^9 /L at day 28 after the first time treatment with decitabine show the higher ORR and longer PFS time,therefore.the lymphocyte level at day 28 after first time treatment with decitabine can be used as an early clinical indicator for predecting the response to decitabine treatment.