Decitabine for Relapsed Acute Lymphoblastic Leukemia after Allogeneic Hematopoietic Stem Cell Transplantation

Relapse after allogeneic hematopoietic stem cell transplantation（allo-HSCT） remains a main question on treatment failure. Current strategies for management that usually include salvage chemotherapy, donor lymphocytic infusion and second transplantation. Our study assessed the efficacy of decitabine（DAC） for treating patients with acute lymphoblastic leukemia（ALL） who relapsed after allogeneic hematopoietic stem cell transplantation（allo-HSCT）. We retrospectively analyzed the outcomes of 12 patients with relapsed ALL after allo-HSCT who received DAC therapy. Nine patients received DAC combined with chemotherapy and donor stem cell infusion, and 3 patients received single-agent DAC. Ten of the 12 patients achieved complete remission（CR）, 1 achieved a partial remission（PR）, and 1 had no response（NR） after treatment at the latest follow-up（LFU）, the median survival was 11.2 months（range, 3.8–34, 7 months）. The 1-and 2-year overall survival（OS） rates were 50%（6/12） and 25%（3/12）, respectively. Five patients were still alive; 4 had maintained CR and 1 was alive with disease. Patients with Philadelphia chromosome-positive ALL had higher survival rate than patients with Philadelphia chromosome-negative ALL（57.1% vs. 20%）. No aggravated flares of graft-versus-host disease（GVHD） were observed during DAC treatment. Therefore, DAC may be a promising therapeutic agent for ALL recurrence after allo-HSCT.

Therapeutic effect of folic acid combined with decitabine on diabetic mice

AIM:To evaluate the therapeutic effect of folic acid combined with decitabine on diabetic mice.METHODS:The diabetic model of db/db mice were randomly divided into model group,folic acid group,decitabine group,folic acid combined with decitabine group,and C57 mice as normal control group.The density of retinal blood vessels and retinal thickness were detected by fundus photography and optical coherence tomography,respectively.Pathological changes of retina were observed by hematoxylin-eosin(HE)staining.The homocysteine(Hcy)in serum was detected by enzyme linked immunosorbent assay(ELISA).TdT-mediated dUTP nick-end labeling(TUNEL)was used to detect apoptosis in retinal tissue.Evans blue dye was used to detect the permeability of retinal blood vessels.The platelet endothelial cell adhesion molecule-1(CD31)and vascular endothelial growth factor receptor(VEGFR)protein were detected by Western blot.The 3-nitrotyrosine(3-NT)and 4-hydroxynonanine(4-HNE)were detected by immunohistochemistry.RESULTS:The density of retinal blood vessels,retinal thickness,retinal vascular permeability and the proportion of apoptotic cells of retinal tissue in the model group increased significantly than control group(P<0.05).The Hcy in serum and the levels of CD31,VEGFR,3-NT,and 4-HNE in retinal tissue increased significantly in the model group(P<0.01).Folic acid and decitabine both reversed these changes significantly,and the combination of the folic acid and decitabine worked best.CONCLUSION:The combination of folic acid and decitabine has a more significant protective effect on the retina in diabetic mice.

Platelet Doubling After First Decitabine Cycle Predicts Response and Survival of Myelodysplastic Syndrome Patients

Objective:Although the effect of decitabine on myelodysplastic syndrome(MDS)has been demonstrated,merely a proportion of patients respond to therapy,and no well-recognized predictors have been identified.This study was conducted to investigate the effectiveness of decitabine in real-world clinical practice,and determine the predictive factors of response and overall survival(OS)in MDS patients.

More Benefits of Oral Administration of Arsenic-containing Qinghuang Powder Compared with Decitabine for High/Very-high Risk Myelodysplastic Syndrome

OBJECTIVE: To evaluated the benefits of oral administration of arsenic-containing Qinghuang Powder(QHP)compared with decitabine for patients with high/very-high(H/VH) risk myelodysplastic syndrome(MDS) according to the Revised International Prognostic Score System. METHODS: The OS(mOS) rate, annual OS rate and progression to acute myeloid leukemia(AML) in patients with H/VH MDS treated with QHP(QHP group, n = 27) and decitabine(decitabine group, n = 20) were retrospectively analyzed. The effects of prognostic factors of age, proportion of bone marrow blast,peripheral blood cell count, karyotype and Charlson Comorbidity Index(CCI) on OS were further analyzed. RESULTS: The m OS rate of QHP group(29 months) was signi?cantly longer than that of the decitabine group(18 months)(P = 0.043). The OS rates of 1, 2, and 3 years were signi?cantly higher in the QHP group(88.9%, 59.3%, 29.6%) than that in the decitabine group(70%, 25%, and 5%)(P = 0.01). There was no signi?cant difference of 5-year OS rate between the 2 groups(P = 0.133).The effects of prognostic factors on mOS were further analyzed, and it was found that there was no signi?cant difference of m OS rate between the QHP group(29 months) and the decitabine group(21 months) in the patients with age 65 years old(P = 0.673). The mOS rate was signi?cantly longer in QHP group(28.5 months) than that in decitabine group(18 months) in the patients with age of < 65 years old(P = 0.04). The proportions of bone marrow blast cells with 10% or < 10% had no signi?cant effects on the mOS rate of patients in the 2 groups(P = 0.429, P = 0.183). In patients with HGB 80 g/L, mOS rate was signi?cantly longer in the QHP group(57 months) than that in the decitabine group(21 months)(P = 0.047), while in patients with HGB < 80 g/L, there was no signi?cant difference of mOS rate between the 2 groups(P = 0.265). In the patients with PLT < 50×10~9/L, the mOS rate was signi?cantly longer in the QHP group(33 months) than that in the decitabine group(16 months)(P = 0.028). In the patients with PLT 50×10~9/L, there was no signi?cant difference of the mOS rate between the 2 groups(P = 0.338). In the patients with ANC < 0.8×10~9/L, the mOS rate was signi?cantly longer in the QHP group(20 months) than that in the decitabine group(7 months)(P = 0.014). In the patients with normal karyotype, the mOS was signi?cantly longer in the QHP group(32 months) than that in the decitabine group(15 months)(P = 0.009). In the patients with abnormal karyotypes, there was no significant difference of the mOS rate between the 2 groups(P = 0.882). In the patients with good karyotypes, the mOS rate was signi?cantly longer in the QHP group(37 months) than that in the decitabine group(20 months)(P = 0.019). In the patients with moderate/poor/very poor karyotype, there was no signi?cant difference of the mOS rate between the 2 groups(P = 0.685). In the patients with CCI 3, the mOS rate was signi?cantly longer in the QHP group(34 months) than that in the decitabine group(10.5 months)(P = 0.017). In patients with CCI < 3, there was no signi?cant difference of the mOS rate between the 2 groups(P = 0.581). The proportion of progression to AML in the QHP group(18.8%) was signi?cantly lower than that in the decitabine group(25%)(P = 0.03). CONCLUSION: Compared with decitabine, oral administration of arsenic-containing Qinghuang Powder could help patients to survive longer and decrease incidence of progression to acute myeloid leukemia in the treatment of patients with high/very high MDS.

Treatment of refractory/relapsed extranodal NK/T cell lymphoma with decitabine plus anti-PD-1:A case report

BACKGROUND Extranodal natural killer/T cell lymphoma,nasal type(ENKL) is a highly aggressive malignancy characterized by its association with Epstein-Barr virus(EBV) and extranodal involvement,which shows a poor clinical outcome.Although L-asparaginase-based chemotherapy has improved the response rates of relapsed/refractory(R/R) ENKL,relapse occurs in up to 50% of patients with disseminated disease.CASE SUMMARY Immune evasion has emerged as a critical pathway for survival in ENKL and may be effectuated via STAT3-driven upregulation of programmed cell death ligand 1(PD-L1) or other molecular pathways.Anti-PD-1 is effective for R/R ENKL with EBV-driven upregulation of PD-L1 expression.Anti-PD-1 combined with decitabine showed positive preliminary results in a patient with R/R ENKL and resistance to anti-PD-1.CONCLUSION The treatment experience,in this case,demonstrated the potential ability of decitabine combined with PD-1 inhibitor to treat R/R ENKL,thus providing a new treatment strategy for this tumor.

Efficacy and safety of combined decitabine and ruxolitinib in the treatment of chronic myelomonocytic leukemia

Objective The aim of the study was to evaluate the clinical efficacy of decitabine(DEC)combined with ruxolitinib(RUX)in the treatment of chronic myelomonocytic leukemia(CMML).Methods The clinical characteristics of 12 patients with CMML were analyzed retrospectively and subsequent target sequencing was performed to investigate the efficacy of the combined treatment with DEC and RUX and the molecular signatures therein.Results Among the 12 cases,clinical improvement was observed in all patients(100%),spleen reduction was observed in six patients(67%),and hematologic improvement was observed in four patients(33%).In the CMML-1 group,the overall response was 50%(3/6),one case achieved complete response,one achieved bone marrow remission,and one achieved hematological improvement.In the CMML-2 group,the overall response was 17%(1/6),one case achieved complete response,four showed disease progression(PD),and one exhibited no response.As expected,ASXL1 mutation was predictive for the outcome of CMML(hazard ratio of 2.97,95%confidence interval of 1.21–7.06;P=0.02).Conclusion The use of DEC combined with RUX in the treatment of CMML effectively improved the clinical response and quality of life,especially for CMML-1 patients.Ongoing clinical trials will further evaluate the safety and efficacy of this novel therapeutic approach.

The Effect of Decitabine Combined with Arsenic Trioxide on DAPK Gene and HL-60 Cell Proliferation and Apoptosis

Purpose: Our study was to detect the effect of Decitabine (DAC) combined with arsenic trioxide (AS2O3) on DAPK gene and HL-60 cell proliferation and apoptosis. Methods: DAC and AS2O3 monotherapy, combination treatment and DAC pretreatment were used in this study after incubating with HL-60 cell for 24 h, 48 h, 72 h. CCK8 was used to detect the cell proliferation of HL-60 cell. Flow cytometry was used to detect the cell apoptosis. Then, we used RT-PCR to obtain the gene expression level of DAPK. Results: HL-60 cells were treated with different concentrations of DAC (20 μmol/L, 40 μmol/L, 80 μmol/L), AS2O3 (1 μmol/L, 2.5 μmol/L, 5 μmol/L) monotherapy for 24 h, 48 h, 72 h;along with the extension of the drug concentration and time, proliferation inhibition rate had gradually increased. Monotherapy of DAC, AS2O3 could inhibit the proliferation and induce apoptosis of HL-60 cells, and was time- and dose-dependent. DAC (80 μmol/L) was firstly used for pretreatment, and then, different concentrations of AS2O3 (1 μmol/L, 2.5 μmol/L, 5 μmol/L) were used for 24 h, 48 h, 72 h. It was found that cell proliferation inhibition rate and apoptosis rate had increased significantly. When the two drugs were used together, the increasing proliferation inhibition rate, apoptosis rate and DAPK had become more obvious. Conclusion: DAC and AS2O3 had a synergetic effect for the HL-60 cell proliferation inhibition, apoptosis and expression of DAPK.

T/myeloid mixed-phenotype acute leukemia treated with venetoclax and decitabine:A case report

BACKGROUND Mixed-phenotype acute leukemia(MPAL)is characterized by acute undifferentiated leukemia with blasts co-expressing myeloid and lymphoid antigens.However,consensus regarding the ideal management strategy for MPAL is yet to be established,owing to its rarity.CASE SUMMARY A 55-year-old male was diagnosed with T/myeloid MPAL.Vincristine,prednisolone,daunorubicin,and L-asparaginase were administered as induction chemotherapy.Septic shock occurred 10 days after induction,and bone marrow examination following recovery from sepsis revealed refractory disease.Venetoclax and decitabine were administered as chemotherapy-free induction therapy to reduce the infection risk.There were no serious infections,including febrile neutropenia,at the end of the treatment.After receiving two additional cycles of venetoclax/decitabine,the patient underwent haploidentical peripheral blood stem-cell transplantation and achieved complete response(CR)to treatment.CONCLUSION CR was maintained in a patient with MPAL who underwent haploidentical peripheral blood stem-cell transplantation after additional venetoclax/decitabine cycles.

AIC AR and Decitabine Enhance the Sensitivity of K562 Cells to Imatinib by Promoting Mitochondrial Activity

Although the advent of tyrosine kinase inhibitors(TKIs)has dramatically improved the survival of patients with chronic myeloid leukaemia(CML),acquired drug resistance and TKI-insensitive leukaemic stem cells(LSCs)remain major obstacles to a CML cure.In recent years,the reprogramming of mitochondrial metabolism has emerged as a hallmark of cancers,including CML,and in turn may be exploited for therapeutic purposes.Here,we investigated the effects of several drugs on the mitochondrial function of the CML cell line K562 and found that 5-aminoimidazole-4-carboxamide ribotide(AICAR)and decitabine could effectively increase the ATP content and mitochondrial biogenesis.In addition,these two drugs induced cell cycle arrest and a decrease in colony-forming capacity and promoted K562 cell differentiation.Moreover,we demonstrated that treatment with AICAR or decitabine enhanced the sensitivity o f K562 cells to imatinib,as evidenced by a combination treatment assay.Altogether,our findings indicate that TKIs combined with mitochondrial regulation may provide a therapeutic strategy for the treatment of CML.

Acute myelomonocytic leukemia and T-lymphoblastic lymphoma as simultaneous bilineage hematologic malignancy treated with decitabine:A case report

BACKGROUND Simultaneous bilineage hematologic malignancies are rare;however,several cases of acute myeloid leukemia(AML)and T-lymphoblastic lymphoma(T-LBL)cooccurrence have been reported.A standard treatment for simultaneous AML and T-LBL has not yet been established,and its prognosis is very poor.Further studies to develop standard treatments are required to increase patient survival rates.CASE SUMMARY A 69-year-old man complaining of pleuritic chest pain visited the emergency room.Computed tomography revealed multiple enlarged lymph nodes(LNs)in the neck and groin and pulmonary thromboembolism with pulmonary infarction.Furthermore,a peripheral blood smear performed due to leukocytosis revealed circulating blasts.Acute myelomonocytic leukemia(AMML)was diagnosed after bone marrow examination,and T-LBL positivity for terminal deoxynucleotidyl transferase,cluster of differentiation(CD)34,and CD4 was confirmed by cervical LN biopsy.Decitabine and dexamethasone were administered because he could not receive intensive chemotherapy due to poor performance status.Complete remission of AMML and T-LBL was achieved after 4 cycles of decitabine plus dexamethasone.CONCLUSION We report the therapeutic effect of decitabine,a hypomethylating agent(HMA),in patients with concurrent bilineage hematologic malignancies and suggest that further studies are required to evaluate the therapeutic effect of HMAs on both lymphoid and bilineage hematologic malignancies.

Clinical Efficacy of Decitabine/Azacitidine in Combination with HAG in the Treatment of Elderly Patients with Acute Myeloid Leukemia

This study was conducted to investigate the clinical effect of combining decitabine/azacitidine with HAG in the treatment of single elderly patients with acute myeloid leukemia.Patients in Shaanxi Provincial People’s Hospital were selected for this study from January 2020 to January 2022,and all of the patients were elderly patients with acute myeloid leukemia.Around 23 patients were selected for this study,subsequently the patients were divided into two groups;Group A contained 11 patients and was given decitabine in combination with HAG;and Group B contained 12 patients,and was given azacitidine in combination with HAG.This study showed that the treatment effective rates of patients in both groups were 90.91%and 58.33%,respectively,with a small difference(p>0.05)in the data comparison.The incidence of adverse reactions in the two groups was 63.64%and 16.67%,respectively,with the incidence in group B is significantly(p<0.05)lower compared with group A.Meanwhile,compared with group B,patients in group A had a significantly(p<0.05)shorter mean time to WBC normalization,higher HB and PLT levels,lower WBC levels were lower,all the survival duration times were longer,and subpopulation indicators of peripheral blood T lymphocytes were more in line with normal values.In summary,this study demonstrated that the combination of azacitidine and HAG therapies for the treatment of elderly patients with acute myeloid leukemia is more effective,furthermore can reduce significantly the incidence of adverse treatment effects in patients.

A Study on the Effectiveness of Decitabine Combined with a Half-Dose Priming Regimen in the Treatment of Elderly Patients with Acute Myeloid Leukemia

Objective:To investigate the clinical effects of combining decitabine with a half-dose priming regimen in the treatment of elderly patients with acute myeloid leukemia.Methods:This study was conducted in Shaanxi Provincial People's Hospital from January 2019 to January 2022.Sxty patients were recruited as the research subects.The patients received different treatments and were randomly divided into two groups,with 30 cases in each group,one of which was treated with conventional priming regimen(control group),and the other was treated with decitabine combined with a half-dose priming regimen(study group).The two groups were compared and analyzed in terms of the effectiveness of treatment.Results:The rate of symptom relief in the study group was 96.67%,which was significantly higher than that in the control group(76.67%)(p<0.05).Before treatment,there was no significant difference in the quality-of-life scores between the two groups,with p>0.05.The patients in the study group had sigificantly longer discase free survival and overall survival than those in the control group,with p<0.05.The effectiveness of treatment in the study group was also better.Conclusion:The use of decitabine im combination with a half dose priming regimen for the treatment of elderly patients with acute myeloid lcukemia is effective in improving patients'quality of life,relieving symptoms.and prolonging their survival.

小剂量地西他滨通过调节巨噬细胞极化改善肥胖相关胰岛素抵抗的研究

背景脂肪组织巨噬细胞(adipose tissue macrophages,ATMs)在介导肥胖诱导的胰岛素抵抗中起关键作用。体外实验发现,地西他滨可以调节巨噬细胞极化,至于其在ATMs以及肥胖相关胰岛素抵抗中的作用尚不明确。目的利用体内、体外模型,检测地西他滨是否可以调节ATMs向M2极化,减轻肥胖相关的胰岛素抵抗。方法高脂喂养制作胰岛素抵抗小鼠模型,通过胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)、腹腔胰岛素耐量试验、Western blot检测地西他滨对肥胖小鼠胰岛素敏感性的影响。提取小鼠脂肪组织,检测脂肪组织炎症水平;采用免疫荧光染色、流式细胞分析检测ATMs数量及表型的变化。体外研究中,将3T3-L1脂肪细胞诱导为脂肪细胞,随机分为对照组、M1组、M2组,分别与PBS、LPS+IFN-γ刺激的巨噬细胞、地西他滨处理后巨噬细胞共培养,Western blot检测脂肪细胞PI3K和p-AKT的表达。结果地西他滨处理后,肥胖小鼠的空腹胰岛素和HOMA-IR下降(P<0.05),脂肪组织、肝组织和肌肉组织的胰岛素敏感性均得到改善(P<0.05)。与肥胖组相比,地西他滨处理后脂肪组织炎症减轻,CD11c、iNOS(M1型巨噬细胞)表达下调,CD206、Arg-1(M2型巨噬细胞)表达上调,差异均有统计学意义(P<0.05)。体外实验中,脂肪细胞与LPS+IFN-γ刺激的巨噬细胞共培养后PI3K、p-AKT表达下降,而与地西他滨处理后的巨噬细胞共培养,下降的PI3K、p-AKT表达显著上调(P<0.05)。结论地西他滨可以减轻肥胖相关胰岛素抵抗,该效果可能源于地西他滨促进巨噬细胞向抑炎型M2型转化,减轻慢性炎症。

超低剂量地西他滨联合GHA预激治疗复发难治性急性髓系白血病疗效研究

目的探讨超低剂量地西他滨联合高三尖杉酯碱(HHT)、阿糖胞苷(Ara-c)和粒细胞集落刺激因子(G-CSF)的GHA预激方案治疗复发难治性急性髓系白血病(AML)的临床疗效及其安全性。方法回顾性分析2018年1月—2023年8月在我院接受2个疗程超低剂量地西他滨联合GHA预激方案(具体为:地西他滨10 mg/d,静脉滴注,第1~5天;HHT 1 mg/d,静脉滴注,第1~14天;Ara-c 10 mg,q 12 h,皮下注射,第1~14天;G-CSF 300μg,皮下注射,第0~14天)治疗的28例复发难治性AML患者的临床资料,评价治疗效果及不良反应。结果2疗程后共有17例患者获得完全缓解(CR)(60.7%),6例获得部分缓解(PR)(21.4%),总有效率(ORR)82.1%。26例(92.9%)患者发生IV级骨髓抑制,中性粒细胞缺乏的比例为85.7%(24例),平均持续时间7 d(3~14 d);血小板<20×10^(9)/L的比例为89.3%(25例),平均持续时间8 d(5~17 d)。非血液系统不良反应轻微,无早期死亡发生。结论超低剂量地西他滨联合GHA预激方案治疗复发难治性AML缓解率高,耐受性好,可在临床推广应用。

地西他滨治疗老年骨髓增生异常综合征的疗效以及与TP53基因突变的相关性

目的探讨不同剂量地西他滨治疗老年骨髓增生异常综合征(MDS)的疗效及不良反应,以及TP 53突变对疗效的影响。方法选取本院2020年4月至2022年5月收治的MDS病人共52例,所有病人按照入院先后及适应证分为A组(地西他滨20 mg/d×5 d)28例、B组(地西他滨10 mg/d×10 d)24例,比较2组6周期治疗结束后的临床疗效、不良反应以及地西他滨疗效与TP 53基因突变之间的相关性。结果A组总有效率为39.3%,B组总有效率为37.5%,2组总有效率差异无统计学意义。2组3~4级中性粒细胞减少、3~4级血小板减少、3~4级贫血发生率差异无统计学意义;2组感染、肝脏受损、发热、胃肠道反应发生率差异无统计学意义。TP 53突变型组治疗总有效率为83.3%,TP 53野生型组有效率为12.9%,2组差异有统计学意义(P<0.01)。结论地西他滨20 mg/d×5 d和地西他滨10 mg/d×10 d治疗方案的总有效率相当,不良反应发生率相当,但TP 53突变型病人对地西他滨的反应率明显高于野生型。

竹节香附素A联用地西他滨对肝癌细胞QGY-7703甲基化及凋亡研究

目的探讨竹节香附素A(Raddeanin A,RDA)联用地西他滨(Decitabine,DEC)对人肝癌细胞QGY-7703侵袭迁移、甲基化及凋亡的影响。方法以肝癌细胞QGY-7703为研究对象,RDA和DEC处理细胞,CCK-8法检测细胞毒性;transwell实验检测细胞侵袭、迁移能力;DNA甲基化定量试剂盒(亚硫酸氢盐法)测定DNA甲基化水平;RT-PCR检测DNMT1、DNMT3a、DNMT3b mRNA表达情况;Western-blot检测DNMT1、DNMT3a、DNMT3b蛋白表达情况;AnnexinV-FITC染色法检测细胞凋亡情况。结果RDA和DEC对QGY-770348 h的IC 50为5.74μmol/L、4.91μmol/L;RDA、DEC、联合给药对QGY-7703的侵袭抑制率为44.83%、55.17%、84.48%,迁移抑制率为38.45%、58.17%、82.69%;5-甲基胞嘧啶含量空白组为14.78±0.85、RDA组为9.60±0.29、DEC组为4.2±0.02、联合给药组为3.26±0.21;与空白组比较,DEC组能够降低DNMT1、DNMT3a、DNMT3b mRNA和蛋白的表达(P<0.01,P<0.05),RDA能降低DNMT1、DNMT3a、DNMT3b mRNA和DNMT3a、DNMT3b蛋白的表达(P<0.01,P<0.05),与EDC组比较,联合给药组DNMT3a mRNA表达水平和DNMT3a、DNMT3b蛋白表达水平显著降低(P<0.01,P<0.05)。结论RDA与DEC联合用药可以降低QGY-7703细胞侵袭、迁移能力,通过抑制DNA甲基转移酶来降低DNA甲基化水平,并促进细胞的凋亡。

地西他滨联合预激方案治疗首程标准诱导化疗未缓解初诊AML患者的效果观察

目的:探讨地西他滨联合预激方案治疗首程标准诱导化疗未缓解初诊急性髓系白血病(AML)患者的疗效及对调节性T淋巴细胞(Treg)相对含量的影响。方法:收集2013年3月-2019年3月陕西省人民医院收治的102例初诊经首程标准诱导化疗未缓解的AML患者(除急性早幼粒细胞白血病)的临床资料进行回顾性分析,根据治疗方案不同对患者进行分组,51例采用预激方案治疗为常规组,51例采用地西他滨联合预激方案治疗为联合组。比较两组疗效、毒副反应发生率、治疗前后生活质量核心量表(QLQ-C30)评分、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、Treg)及3年总生存率。结果:联合组治疗总有效率为80.39%,显著高于常规组的62.75%(P<0.05);治疗后联合组QLQ-C30评分为60.27±6.96,较常规组65.73±7.96低(P<0.001);两组毒副反应发生率比较,差异无统计学意义(P>0.05);治疗后联合组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平较常规组高(均P<0.001),而Treg水平较常规组低(P<0.001);联合组3年总生存率为72.55%,高于常规组的52.94%(P<0.001)。结论:地西他滨联合预激方案治疗初诊首程标准诱导化疗未缓解AML患者效果显著,可通过调节Treg相对含量减少抗肿瘤免疫抑制,增强机体免疫功能,从而延长患者生存时间,提高生存质量,且未增加不良反应。

MDS基因突变及三种剂量DAC联合预激方案治疗的疗效观察

目的 探讨MDS细胞分子遗传学临床特点及三种剂量DAC联合预激方案治疗的疗效。方法 采用WHO-MDS诊断分型标准,用G/R显带染色体分析;NGS二代测序突变基因;三种不同剂量DAC联合预激化疗方案治疗中高危MDS患者86例,A组(DAC20mg/m^(2)),B组(DAC15mg/m^(2)+CAG),C组(DAC15mg/m^(2))。结果 在86例MDS患者中,共检测到55(63.95%)例基因突变。共检测到26种基因突变类型。分别是:FLT3,TET2,CEBPA,NPM1,RUNX1,STAG2,IDH2,DNMT3A,WT1,EZH2,GATA2,IKZF1,ASXL1,NRAS,SRSF2,RAD21,TP53,CSF3R,IDH1,ETV5,SMC3,AML1-ETO,SF3B1。前5位的基因是:TET2,DNMT3A,ASXL1,SF3B1,NRAS。治疗方案完成≥2疗程患者占94.2%;有效率:A组(93.3%),B组(96.4%),C组(92.8%);ORR 80.8%。完成≥4疗程患者例占84.8%:有效率:A组(86.7%),B组(85.7%),C组(82.1%);ORR 84.9%。A、B、C 3组间有效率χ2检验无显著性差异(P>0.05)。结论 三种不同剂量地西他滨组合方案均可用于中高危MDS患者。根据患者体能状况评分系统选择个体化治疗中高危MDS更为重要。