71例中高危骨髓增生异常综合征患者化学药物治疗方案选择与生存分析

Chemotherapy Regimen Selection and Survival Analysis of 71 Patients with Intermediate or High-Risk Myelodysplastic Syndrome

目的探讨中高危骨髓增生异常综合征(MDS)患者的化学药物治疗(简称化疗)方案及预后。方法选取医院血液内科2015年1月至2020年10月收治的MDS国际预后评分系统(IPSS)危险分层为中高危的MDS患者71例,按治疗方案的不同分为接受去甲基化药物(HMA)治疗组(HMA组)和HMA联合化疗组(联合化疗组)的,回顾性分析患者的临床资料,并进行疗效评估及生存分析。结果与HMA组比较,联合化疗组患者治疗前的IPSS危险分层更严重,骨髓原始细胞百分比更高(P<0.05),疗效、总生存率(OS)、无白血病生存率(LFS)无显著差异(P>0.05)。初诊时髓系原始细胞百分比小于分界值[4.395%,由接收者操作特征(ROC)曲线得到]的非化疗组患者的OS比化疗组更高(P=0.0256),在髓系原始细胞百分比<10%的患者中得到相似结果。结论部分MDS患者初诊时IPSS危险分层及骨髓原始细胞百分比较高,其可能需要行HMA联合化疗,但对于初诊时髓系原始细胞百分比小于4.395%的患者,化疗前需谨慎评估。

Objective To investigate the chemotherapy regimen and prognosis of patients with intermediate or high-risk myelodysplastic syndrome(MDS).Methods A total of 71 patients with International Prognosis Score System(IPSS)hazard stratification intermediate or high-risk MDS who received chemotherapy in the Department of Hematology of the hospital from January 2015 to October 2020 were selected,and they were divided into hypomethylating agents(HMA)treatment group(HMA group)and HMA combined with chemotherapy group(combined chemotherapy group)according to different treatment schemes.The patients′clinical data were retrospectively analyzed,and efficacy evaluation and survival analysis were performed.Results Before treatment,the IPSS hazard stratification and the percentage of myeloid blasts in the combined chemotherapy group were higher than those in the HMA group(P<0.05),while the efficacy,overall survival rate(OS),and leukemia survival rate(LFS)between the two groups had no significant difference(P>0.05).Patients whose percentage of myeloid blasts was less than the cut-off value[4.395%,according to the receiver operating characteristics(ROC)curve]at the initial diagnosis had a higher OS in the non-chemotherapy group than those in the chemotherapy group(P=0.0256),and similar results were obtained in patients with myeloid blasts percentage lower than 10%.Conclusion The IPSS hazard stratification and the percentage of myeloid blasts in some MDS patients is high at the initial diagnosis,these patients may need HMA combined with chemotherapy.However,more caution should be taken before using chemotherapy for patients with a percentage of myeloid blasts lower than 4.395%at the initial diagnosis.