Methods and New Developments in the Treatment of Hematological Diseases with Integrated Traditional Chinese and Western Medicine

Objective:To understand the methods and progress of integrated Chinese and Western medicine in the treatment of hematological diseases,and to provide ideas for integrated Chinese and Western medicine in the treatment of hematological diseases.Methods:Searching the CNKI,Wanfang and Weipu databases with"integrated traditional Chinese and Western medicine","hematological disease",and"traditional Chinese medicine"as the key words,for related literature of integrated traditional Chinese and Western medicine in the treatment of hematological disease,screening and analyzing the literature.Results:After decades of development,the methods of integrated traditional Chinese and Western medicine in the treatment of hematological diseases have been developed from initial exploration to clinical practice,from wide application to recent progress.The combination methods include the combination of Western medicine and traditional Chinese medicine,as well as the combination of Western medicine and non-medicine of traditional Chinese medicine.The combination of traditional Chinese and Western medicine includes the combination of Chinese and Western medicine,sequential and alternate methods,etc.The combination of traditional Chinese and Western medicine in the treatment of hematological diseases has significant effects in enhancing efficiency and reducing toxicity,improving the quality of life and prolonging the survival period.Conclusion:The combination of traditional Chinese and Western medicine has obvious curative effect,high safety and various methods in treating hematologic diseases.

Clinical Factors Affecting Platelet Growth in the Treatment of Aplastic Anemia by Tonifying Kidney and Generating Blood

Objective:To investigate the influence of kidney-tonifying and blood-generating method on platelet(PLT)growth in the treatment of aplastic anemia(AA)and analyze the characteristics of the clinical factors affecting PLT growth.We enrolled patients treated from September 2018to March 2021 in the China Academy of Traditional Chinese Medicine(TCM)Xiyuan Hospital,China Academy of TCM hospital gate 19sub-center.We enrolled 128 AA patients,for whom the inclusion criteria were:treatment is given priority to with kidney and heart's-blood method,on the basis of western medicine treatment for kidney fill party avoid Fried instant particles,stay for 3 months for a period of treatment,taking two consecutive period of treatment,changes in the PLT were observed,and the clinical characteristics of AA patients,such as PLT growth and recovery from baseline value,were analyzed.Materials and Methods:A total of 128 AA patients from 19 branches of Xiyuan Hospital,China Academy of Chinese Medical Sciences and Guang'anmen Hospital,China Academy of Chinese Medical Sciences treated from September 2018 to March 2021 were enrolled.The treatment was based on the kidney-tonifying and blood-generating method and lasted for 3 months as a course of treatment.The changes in the number of PLT in patients were observed,and the clinical characteristics of AA affecting PLT growth and recovery from baseline value were analyzed.Results:After 6 months of treatment following the kidney-tonifying and blood-generating method,PLT increased from the baseline values in 75 cases,including 21 cases of AA with normal PLT recovery and 54 cases of AA without normal PLT recovery.There were 53 cases of AA in whom PLT did not increase from the baseline.Analysis of the general data showed that patients with lower Karnofsky Performance Status(KPS)score were more likely to experience PLT growth or even return to normal after therapy(P<0.05).The results of routine blood analysis showed that when hemoglobin(HGB)was≥60 g/L and the reticulocyte(RET)proportion was≥0.3%before treatment,PLTs were more likely to increase,even returning to normal in some patients(P<0.05).Analysis of bone puncture results before treatment showed that when the proliferation of nucleated cells was low or extremely low in bone puncture examination,with the proportion of granulocytes<40%,and the proportion of erythroid cells<20%,the treatment method was more effective at increasing PLT count(P<0.05).Analysis of the chromosome karyotype results before treatment showed that when the chromosome karyotype was normal,PLTs were more likely to increase or even return to normal after treatment(P<0.05).Analysis of T-lymphocyte subsets before treatment showed that when CD3+human leukocyte antigen(HLA)-DR+proportion was≥30%,PLTs were more likely to increase or even return to normal(P<0.05).Conclusions:AA patients with a low KPS score,higher HGB≥60 g/L,RET proportion≥0.3%,low or extremely low proliferation of nucleated cells,granulocytes proportion<40%,erythroid proportion<20%,normal chromosome karyotype,CD3+HLA-DR+≥30%,should be treated with a kidney-tonifying and blood-generating method.Such patients are more likely to show PLT growth and the values may even return to normal.

Application and Assessment of Chinese Arsenic Drugs in Treating Malignant Hematopathy in China

Chinese arsenic drugs have been applied in Chinese medicine for several centuries. Beginning from 1970s, arsenic containing drugs have been generally used for the treatment of malignant hematologic diseases including acute promyelocytic leukemia, myelodysplastic syndrome, and multiple myeloma. No matter what ingredients of arsenic drugs were applied, either arsenic trioxide, arsenic disulfide, or arsenic containing Chinese herbal compositions including Qinghuang Powder （青黄散） and Realgar-lndigo naturalis formula （复方黄黛片）, they all provided the distinct approaches for the management of malignant hematologic diseases, and good clinical efficacy was obtained with mild adverse reactions. Moreover, the mechanisms of action have been continuallv elucidated.

Clinical Observation of the Treatment of Myelodysplastic Syndrome Mainly with Qinghuang Powder(青黄散)

Objective： To observe the clinical effectiveness of Qinghuang Powder （青黄散, QHP） combined with Bupi Yishen Decoction （补脾益肾汤 BPYS） in treating myelodysplastic syndrome （MDS）, and its relationship with France, America, and Britain （FAB） type, international prognosis scaling system （IPSS） risk, and chromosome karyotype. Methods： There were 124 MDS patients subjected to the tests. By FAB typing, 91 patients were typed as refractory anemia （RA） type and 33 as refractory anemia with excess of blasts （RAEB） type; by IPSS scale, 21 were sorted to low risk, 77 to moderate risk I, 20 to moderate risk ]], and 6 to high risk; 78 of them had normal chromosome and 46 with abnormal chromosome, including 26 of trisomy 8. All patients were treated with QHP＋BPYS, and the changes of peripheral blood figure and bone marrow were observed. Results： After treatment, the general effective rate was 72.58% （90/124）, which in the patients of RA type was 80.22% （73/91） and in RAEB type 51.52% （17/33）. The former was better than that in the later （P〈0.01）. For the analysis in the patients of different IPSS risk degrees, the effective rate was 95.24% （20/21） in the low- risk group, 72.73% （56/77） in moderate risk I, 65.00% （13/20） in moderate-risk 11, and 16.67% （1/6） in high- risk group. Those in the first two groups were superior to that in the latter two （P〈0.01）. The effective rate was 79.49% （61/78） in the patients with normal chromosome and was 60.87% （28/46） in the patients with abnormal chromosome, showing a significant difference between them. While in the patients of trisomy 8, it was 73.08% （19/26）, which was parallel to that in the patients with normal chromosome. Conclusion： The effectiveness of QHP＋BPYS comprehensive therapy for MDS is unquestionably good, and it is markedly correlated with the FAB type and IPSS risk degree of the disease, as well as the normality of chromosome in the patient.

Effect of Qinghuang Powder(青黄散) Combined with Bupi Yishen Decoction(补脾益肾方) in Treating Patients with Refractory Cytopenia with Multilineage Dysplasia through Regulating DNA Methylation

Objective: To explore the effect of Qinghuang Powder(QHP, 青黄散) combined with Bupi Yishen Decoction(BPYS, 补脾益肾方)on myelodysplastic syndromes(MDS) patients with refractory cytopenia with multilineage dysplasia(RCMD) and determine the change of DNA methylation in MDS-RCMD patients after the treatment of Chinese medicine formula. Methods: All 308 MDS-RCMD patients were treated with QHP combined with BPYS for 2 months at least, absolute neutrophil count(ANC), hemoglobin(Hb), platelets(PLT), primitive bone marrow cells and chromosome karyotype were chosen as the main evaluation indexes to analyze the treatment effect according to criteria from the MDS International Working Group. Then 43 bone marrow samples from 15 MDS-RCMD patients and 28 healthy donors were obtained for the examination of DNA methylation.Gene Ontology(GO) and Pathway analysis were applied to analyze the methylation data. Results: The overall MDS response rate to QHP was 61.68%(190/360) including hematologic improvement-neutrophil(HI-N) or hematologic improvement-erythroid(HI-E) or hematologic improvement-platelet(HI-P). Patients with anemia had a better response rate than patients with neutropenia or thrombocypenia(55.88% vs 31.54% or 55.88%vs. 36.9%). The DNA methylation microarray analysis disclosed that 4,257 hypermethylated genes were demethylated upon the treatment with QHP and BPYS. GO analysis and Pathway analysis showed that these demethylated genes were involved in a lot of tumor-related pathways and functions. Conclusions: QHP combined with BPYS could effectively treat MDS-RCMD patients through hematologic improvement(HI-N, HI-P or HI-E)and PLT and RBC transfusion independence due to the demethylation, thereby providing another choice for the treatment of patients with MDS-RCMD.

Effect of Yiqi Tongyang Decoction(益气通阳方) on Blood T Cell Subsets in Patients with Chronic Immune Thrombocytopenia

Objective： To measure the proportions of blood T cel subsets, Th1, Th2, Th17, Th22, and Treg cel s, and other parameters in patients with chronic immune thrombocytopenia（CITP） before and after treatment with Yiqi Tongyang Decoction（益气通阳方, YTD） to explore T cel status of patients with CITP, and to define the mechanism of action of YTD. Methods： The changes in peripheral blood T lymphocyte subsets, and those of Th1, Th2, Th17, Th22, and Treg cel s in 30 patients with CITP（22 females and 8 males） were analyzed using multiparametric flow cytometry before and after treatment with YTD for 6 months, and 26 healthy volunteers（14 males and 12 females） acted as a control. T-box expressed in T-cel s（T-bet） and GATA binding protein 3（GATA-3） m RNA levels in patients and controls were analyzed using real-time reverse transcription-polymerase chain reaction. Results： The proportions of Th1, Th17, Th22, Th1/Th2, and Th17/Treg cells increased in the peripheral blood of patients with CITP compared to those in controls before YTD therapy（P〈0.05）. Th1 cel numbers and the Th1/Th2 ratio fel in the treated patients with CITP to approximate the values of the control group（P〉0.05）. Th17 cel numbers and the Th17/Treg ratio also decreased in the treatment group（P〈0.05）, but not to the levels of the controls. The number of Treg cel s in the peripheral blood of patients with CITP before treatment was lower than that in the control group（P〈0.05）, but increased after YTD treatment（P〈0.05）, but not to the level of controls. T-bet and GATA-3 m RNA levels in peripheral blood were initially higher in patients before treatment than controls（P〈0.05）, but decreased after YTD therapy（P〈0.05）. Conclusions： Imbalances in T lymphocyte levels, particularly those of Th1/Th2 and Th17/Treg cel s, play important roles in the pathogenesis of CITP. YTD efficiently regulated the dynamics of Th1/Th2 and Th17/Treg equilibria.

Effect and Prognostic Analysis of Treatment for Acute Myeloid Leukemia Using Chinese Drugs Combined with Chemotherapy

Objective:To observe the clinical efficacy of Chinese drugs combined with chemotherapy in the treatment of acute myeloid leukemia(AML) and to investigate the prognostic relevance of the main parameters in AML treated with integrative medicine.Methods:Forty AML patients hospitalized at the authors hospital were treated with Chinese drugs and chemotherapy.The routine examination,immunophenotype and karyotype analyses were carried out.The clinical efficacy was observed and the prognostic factors were analyzed...

Analysis of the Prognostic Factors of Very Severe Aplastic Anemia Treated with Chinese Kidney-Invigorating Drugs in Combination with Anti-lymphocyte Globulin or Anti-thymocyte Globulin

Objective： To explore the prognostic factors for very severe aplastic anemia （VSAA） patients treated mainly with Chinese Kidney （Shen）-invigorating drugs （CKID） combined with anti-lymphocyte globulin （ALG） or anti-thymocyte globulin （ATG）. Methods： Twenty-seven VSAh. patients were treated with CSID＋ALG/ ATG therapy in conjunction with cyclosporine A, androgen, hemopoietic growth factor, etc. The relationship of the effectiveness and some factors （age of patients, course of illness, blood and bone marrow figures, etc.） were analyzed. Results： In the 25 evaluated VSAA patients who had been followed up for over 1 year, 9 patients （36.0%） were basically cured, 5 （20.0%） remitted, 6 （24.0%） were markedly improved, and 5 （20.0%） were treated in vain, with the total effective rate of treatment being 80.0% （20/25）. Better clinical therapeutic effects were shown in patients newly diagnosed with VSAA, of male sex （P=0.037）, 〉20 years old （P=0.045）, with an illness course ≤ 1 month （,P=0.048）, with peripheral neutrophil count 〉0.1 × 10^9/L （P=0.023）, and with reticulocyte count 〉10 × 10^9/L （P=0.002）. Platelet count （P=0.620） and bone marrow lymphocyte percentage （P=0.736） showed no correlation with the therapeutic effectiveness. Multi-factor analysis by the Kaplan-Meier procedure on the factors influencing survival showed that rather longer survival times occurred in patients 〉 20 years old, with peripheral neutrophil count ≤〈0.1 × 10^9/L, reticulocyte count ≤10 × 10^9/L, and platelet count 〉 10 × 10^9/L （allP=0.0001）. Bone marrow lymphocyte percentage and the initiation time of ALG/ATG application （from onset of the illness） showed no significant influence on patients＇ survival time （P=0.085 and P=0.935, respectively）. Conclusions： CSKD＋ALG/ATG therapy for treatment of VSAA could enhance the current clinical therapeutic effects and elevate patients＇ survival rate. Conditions including male sex, age 〉20 years, illness course ≤1 month, neutrophil count 〉0.1× 10^9/L, and reticulocyte count 〉10 × 10^9/L are the likely effective indices for predicting favorable therapeutic effectiveness in newly diagnosed VSAA patients.

Association of Gene Mutations with Response to Arsenic-Containing Compound Qinghuang Powder(复方青黄散)in Patients with Myelodysplastic Syndromes

Objective: To in vestigate the relati on ship betwee n gene mutations and resp onse to Compo und Qinghuang Powder (复方青黄散,CQHP) in patients with myelodysplastic syndrome (MDS). Methods: Forty-three MDS patients after treatment with CQHP for 6 months were genotyped by ultra-deep targeted sequencing and the clinical data of patients were collected and the relationship between them was analyzed. Results: Up to 41.86% of patie nts harbored genet mutations, in most cases with more than one mutation. The most comm on mutations were in SF3B1, U2AF1, ASXL1, and DNMT3A. After treatment with CQHP, about 88.00% of patients no longer required blood transfusion, or needed half of prior transfusions. Conlusion: CQHP is an effective treatment for patients with MDS, especially those with gene mutations in SF3B1, DNMT3A, U2AF1, and/or ASXL1.

Relation of Blood Arsenic Concentration with Effect and Safety of Arsenic-Containing Qinghuang Powder (青黄散) in Patients with Myelodysplastic Syndrome

Objective: To investigate the relation of blood arsenic concentration (BAC) with clinical effect and safety of arsenic-containing Qinghuang Powder (青黄散,QHP) in patients with myelodysplastic syndrome (MDS). Methods: Totally 163 patients with MDS were orally treated with QHP for 2 courses of treatment, 3 months as 1 course. The BACs of patients were detected by atomic fluoresce nee spectrophotometry at 1, 3, and 6 months during the treatment, and the effective rate, hematological improvement and safety in patients after treatment with QHP were analyzed. Results: After 2 courses of treatment, the total effective rate was 89.6%(146/163), with 31.3%(51/163) of hematological improvement and 58.3%(95/163) of stable disease. The hemoglobin increased from 73.48 ± 19.30 g/L to 80.39 ± 26.56 g/L (P<0.05), the absolute neutrophil count increased from 0.81 ±0.48 × 10^9/L to 1.08 ±0.62 × 1O^9/L (P<0.05), and no significant changes were observed in platelet counts (P>0.05). Among 46 patients previously depended on blood transfusion, 28.3%(13/46) completely got rid of blood transfusion and 21.7%(10/46) reduced the volume of blood transfusion by more than 50% after treatment. The BACs were significantly increased in patients treated for 1 month with 32.17 ± 18.04 jig/L (P<0.05), 3 months with 33.56 ±15.28 μg/L (P<0.05), and 6 months with 36.78 ±11.92 μg/L (P<0.05), respectively, as compared with those before treatment (4.08 ±2.11 ag/L). There were no significant differences of BACs among the patients treated for 1, 3 and 6 months (P>0.05). The adverse reactions of digestive tract during the treatment were mild abdominal pain and diarrhea in 14 cases (8.6%), and no patients discontinued the treatment. The BACs of patients with gastrointestinal adverse reactions were significantly lower than those without gastrointestinal adverse reactions (22.39 ±10.38 vs. 37.89 ± 11.84,μg/L, P<0.05). The BACs of patients with clinical effect were significantly higher than those failed to treatment (40.41 ± 11.69 vs. 23.84 ± 12.03,μg/L, P<0.05). Conclusion: QHP was effective and safe in the treatment of patients with MDS and the effect was associated with BACs of patients.

Compound Zhebei granules combined with chemotherapy for the treatment of refractory acute leukemia: a randomized clinical trial

OBJECTIVE: To observe the effect of compound Zhebei granules(CZBG) with chemotherapy in the treatment of refractory acute leukemia.METHODS: In this multicenter, double-blind, placebo-controlled clinical trial, we used a central(online) randomization system to assign 235 patients to two treatment groups. A total of 118 patients received chemotherapy combined with CZBG(4 g,twice daily) and 117 patients received chemotherapy plus placebo. The clinical efficacy was evaluated at the end of one chemotherapeutic cycle.RESULTS: In the full analysis set, in which deaths due to disease progression were regarded as inefficacy, the rates of complete remission(CR) and partial remission(CR + PR) were 32.35% and 50.00%,respectively, for the chemotherapy combined with CZBG group, and 23.08% and 35.58%, respectively,for the chemotherapy plus placebo group. There was a statistically significant difference between the two groups according to a ysis set(PPχ2test(P < 0.05). In the per protocol analS), the CR(33.67%),CR+PR(52.04%) response rates for the chemotherapy plus CZBG group were significantly different from the response rates of the control group(CR:24.24% and CR+PR: 37.37%), respectively(P < 0.05).CONCLUSION: CZBG plus chemotherapy can improve the clinical remission rate of refractory acute leukemia after one just one therapeutic cycle.

Arsenic concentration in peripheral blood is correlated with efficacy of a Traditional Chinese Medicine regimen containing realgar for the treatment of myelodysplastic syndromes

OBJECTIVE:To explore the relationship between the efficacy of realgar for the treatment of myelodysplastic syndromes with multilineage dysplasia(MDS-MLD)and arsenic concentration in the peripheral blood of patients.METHODS:In this prospective study,a total of 50 MDS-MLD patients were treated with traditional Chinese drugs containing realgar for 3 months in Xiyuan Hospital from March 2018 to January 2019.Routine blood examination as well as liver and kidney function were monitored before and after treatment.The concentration of arsenic in the peripheral blood was measured using an atomic fluorescence spectrometer after treatment.The correlation between clinical effect and arsenic concentration was analyzed by Spearman’s method.RESULTS:The treatment response rate was 54%.Two patients(4%)achieved complete remission,50%(25 of 50)showed hematologic improvement,and 23 patients had stable disease(23%).No disease progression was observed.Arsenic concentration in the peripheral blood ranged from 14.60 to 85.96μg/L.Clinical efficacy was positively correlated with arsenic concentration(P<0.05).The incidence of mild adverse reactions was 16%.CONCLUSION:A relatively high concentration of arsenic in the peripheral blood may improve the clinical efficacy of realgar in MDS-MLD patients.

Effect of Yiqi Bushen Granule (益气补肾颗粒) on the Peripheral Natural Killer Cell and γ δ T-cell in the Patients with Minimal Residual Leukemia

Objective： To analyze the changes in peripheral natural killer T-cells （NKT） and gammadelta T-cells （γδT-cell） in patients with minimal residual leukemia （MRL） before and after being treated with Yiqi Bushen Granule （益气补肾颗粒, YBG） in order to determine their significance in prognosis of the disease. Methods： Before and after treatment, the changes in 36 patients （16 males and 20 females） receiving long-term （more than 3 months） YBG therapy were analyzed using multi-parameter flow cytometry, with 34 healthy persons （19 males and 15 females） acting as controls. Results： The absolute value and percentage of NKT cells and γδT-cells were all significantly raised after treatment, for NKT cells, 0.52%±0.39% to 0.83%±0.66% and 7.25±7.77 cell/μL to 12.86±11.99 cell/μL, for γδT-cells, 6.08%±3.03% to 7.24%±2.78% and 83.97±48.09 cell/μL to 110.53±54.12 cell/μL, respectively （P0.05 or P0.01）. Conclusion： YBG could regulate the immune function and elevate the amount of NKT cells and γδT-cells, thus to kill or suppress the residual leukemic cell in the body, which might be one of the mechanisms of YBG in prolonging the disease-free survival in MRL patients.

Comparing Arsenic-Containing Qinghuang Powder and Low-Intensity Chemotherapy in Elderly Patients with Acute Myeloid Leukemia

Objective To compare the clinical effect of arsenic-containing Qinghuang Powder(QHP)and low-intensity chemotherapy(LIC)in treatment of elderly acute myeloid leukemia(eAML)patients.Methods Clinical data of 80 eAML patients treated at Xiyuan Hospital of China Academy of Chinese Medical Sciences from January 2015 to December 2020 were retrospectively analyzed.The treatment scheme was designed by real world study according to patients’preference,and patients were divided into a QHP group(35 cases)and a LIC group(45 cases).The median overall survival(mOS),1-,2-,and 3-year OS rates,and incidence of adverse events were compared between the two groups.Results The mOS of 80 patients was 11 months,and the 1-,2-,and 3-year OS rates were 45.51%,17.96%,and 11.05%,respectively.The QHP and LIC groups demonstrated no significant difference in mOS(12 months vs.10 months),1-(48.57%vs.39.65%),2-(11.43%vs.20.04%),and 3-year OS rates(5.71%vs.13.27%,all P>0.05).Moreover,the related factors of mOS demonstrated no significant difference in patients with age>75 years(11 months vs.8 months),secondary AML(11 months vs.8 months),poor genetic prognosis(9 months vs.7 months),Eastern Cooperative Oncology Group performance status score≥(10 months vs.7 months)and hematopoietic stem cell transplant comorbidity index≥4(11 months vs.7 months)between the QHP and LIC groups(all P>0.05).However,the incidence of myelosuppression was significantly lower in the QHP group than that in the LIC group(28.57%vs.73.33%,P<0.01).Conclusions QHP and LIC had similar survival rates in eAML patients,but QHP had a lower myelosuppression incidence.Hence,QHP can be an alternative for eAML patients who do not tolerate LIC.

Arsenic-Containing Qinghuang Powder(青黄散)Is An Alternative Treatment for Elderly Acute Myeloid Leukemia Patients Refusing Low-Intensity Chemotherapy

Objective:To analyze the overall survival(OS)of elderly acute myeloid leukemia(AML)patients treated with oral arsenic-containing Qinghuang Powder(青黄散,QHP)or low-intensity chemotherapy(LIC).Methods:Forty-two elderly AML patients treated with intravenous or subcutaneous LIC(1 month for each course,at least 3 courses)or oral QHP(3 months for each course,at least 2 courses)were retrospectively analyzed from January 2015 to December 2017.The main endpoints of analysis were OS and 1-,2-,3-year OS rates of patients,respectively.And the adverse reactions induding bone marrow suppression,digestive tract discomfort and myocardia injury were observed.Results:Out of 42 elderly AML patients,22 received LIC treatment and 20 received QHP treatment,according to patients'preference.There was no significant difference on OS between LIC and QHP patients(13.0 months vs.13.5 months,P>0.05).There was no significant difference on OS rates between LIC and QHP groups at 1 year(59.1%vs.70.0%),2 years(13.6%vs.15%),and 3 years(4.6%vs.5.0%,all P>0.05).Furthermore,there was no significant difference of OS on prognosis stratification of performance status>2(12 months vs.12 months),age>75 year-old(12.0 months vs.12.5 months),hematopoietic stem cell transplant comorbidity index>2(12 months vs.13 months),poor cytogenetics(12 months vs.8 months),and diagnosis of secondary AML(10 months vs.14 months)between LIC and QHP patients(P>0.05).Conclusion:QHP may be an alternative treatment for elderly AML patients refusing LIC therapy.

Oral Arsenic-Containing Qinghuang Powder:A Potential Drug for Myelodysplastic Syndromes

Qinghuang Powder(QHP),an oral arsenic,has become an effective drug in the treatment of myelodysplastic syndromes(MDS)in Xiyuan Hospital,China Academy of Chinese Medical Sciences for many years,and the action mechanism of the compound or active ingredient AsSof QHP has been elucidated.Considering the relatively safety,chemotherapy-free and convenient oral profile,QHP is widely used in the clinical treatment for MDS patients,especially for elderly patients.In this review,the authors document the efficacy and safety of oral arsenic-containing compound QHP in the treatment of MDS,with a special focus on the association of efficacy of QHP with the cytogenetics,prognostic risk,DNA methylation,gene mutation,blood arsenic concentration,mechanism of action of AsSand the countermeasures against adverse reactions of gastrointestinal tract.