含砷中药复方治疗的高危骨髓增生异常综合征患者的生存特征分析

Survival characteristics of patients with high-risk myelodysplastic syndromes treated with an arsenic-containing herbal combination

目的 探讨高危骨髓增生异常综合征(HR-MDS)患者的临床生存特征,为HR-MDS患者的临床预后评估提供参考。方法 回顾性分析2016年1月—2022年9月在中国中医科学院西苑医院确诊为HR-MDS的200例患者的一般资料、血常规、骨髓涂片,以及组织病理学、细胞遗传学等临床资料。依据不同治疗方法把纳入患者分为含砷中药复方联合去甲基化药物(HMAs)治疗组与含砷中药复方联合雄激素治疗组,分析各组患者临床指标对生存特征的影响。结果 200例接受含砷中药复方联合HMAs或联合雄激素治疗的HR-MDS患者临床指标对生存特征影响比较结果显示,高危与极高危(P=0.018)、血红蛋白(Hb)<80 g/L与Hb≥80 g/L(P=0.035)、血小板(PLT)计数<50×10^(9) L^(-1)与PLT计数≥50×10^(9) L^(-1)(P<0.001)、骨髓增生异常综合征转白血病(MDS-AML)与非MDS-AML(P=0.003)中位无进展生存期(PFS)比较,差异有统计学意义。68例接受含砷中药复方联合HMAs治疗的HR-MDS患者临床指标对生存特征影响比较结果显示:PLT计数<50×10^(9) L^(-1)与PLT计数≥50×10^(9) L^(-1)(P<0.001)、化疗疗程<5个与疗程≥5个(P=0.018)的中位PFS比较,差异有统计学意义。132例接受含砷中药复方联合雄激素治疗的HR-MDS临床指标对生存特征影响比较结果显示,Hb<80 g/L与Hb≥80 g/L(P=0.028)、PLT计数<50×10^(9) L^(-1)与PLT计数≥50×10^(9) L^(-1)(P=0.002)、MDS-AML与非MDS-AML(P=0.024)的中位PFS比较,差异有统计学意义。结论 接受含砷中药复方联合HMAs治疗的PFS延长患者临床特征有PLT计数≥50×10^(9) L^(-1)、化疗疗程≥5个。接受含砷中药复方联合雄激素治疗的PFS延长患者临床特征有Hb≥80 g/L、PLT计数≥50×10^(9) L^(-1)和非MDS-AML。

Objective To investigate the clinical characteristics of survival in patients with high-risk myelodysplastic syndromes(HR-MDS)and provide a reference for the clinical prognosis of patients with HR-MDS.Methods General data,blood routine test,bone marrow smear with histopathology,cytogenetics,and other clinical data of 200 patients diagnosed with HR-MDS at Xiyuan Hospital of China Academy of Chinese Medical Sciences,during the period of January 2016-September 2022,were retrospectively analyzed.The included patients were categorized into the arsenic-containing herbal combination combined with demethylating agents(HMAs)treatment group and the arsenic-containing Chinese medicine compound combined with androgen treatment group.The influence of clinical indices on the survival characteristics of each group was analyzed.Results Comparison of the impact of clinical indicators on survival in 200 patients with HR-MDS who were treated with arsenic-containing herbal compounds in combination with HMAs or androgens showed that high-risk vs.very high-risk(P=0.018),hemoglobin(Hb)<80 g/L vs.Hb≥80 g/L(P=0.035),platelet(PLT)counts<50×10^(9) L^(-1) vs.PLT counts≥50×10^(9) L^(-1)(P<0.001),and the difference in median progression-free survival(PFS)time between myelodysplastic syndromes converted to leukemia(MDS-AML)and non-MDS-AML(P=0.003)were statistically significant.Comparison of survival effects of clinical indicators in 68 patients with HR-MDS who were treated with arsenic-containing Chinese medicine compound combined with HMAs showed that the difference in median PFS between PLT count<50×10^(9) L^(-1) and PLT count≥50×10^(9) L^(-1)(P<0.001)and the difference in median PFS between<5 and≥5 courses of chemotherapy(P=0.018)were statistically significant.Comparison of survival effects of clinical indicators in 132 patients with HR-MDS who were treated with arsenic-containing Chinese medicine compound combined with androgens showed that Hb<80 g/L and Hg≥80 g/L(P=0.028),PLT count<50×10^(9) L^(-1) and PLT count≥50×10^(9) L^(-1)(P=0.002),and the mean differences in PFS between MDS-AML and non-MDS-AML(P=0.024)were statistically significant.Conclusion The clinical characteristics of long-surviving patients treated with arsenic-containing herbal combination in combination with HMAs included PLT counts≥50×10^(9) L^(-1) and≥5 courses of chemotherapy.The clinical characteristics of long-surviving patients treated with arsenic-containing herbal combination in combination with androgens included Hg≥80 g/L,PLT count≥50×10^(9) L^(-1),and non-MDS-AML.