Clinical Efficacy and Prognostic Factors of Decitabine for Treatment of Myelodysplastic Syndrome.
10.7534/j.issn.1009-2137.2018.06.020
- Author:
Zhen-Hua BAO
1
;
Hong-Guo ZHAO
2
;
Hong-E YU
3
Author Information
1. Qiingdao University Medical College,Qiingdao 266000, Shandong Province, China.
2. Department of Hematology, The Affiliated Hospital of Qiingdao University, Qiingdao 266000, Shandong Province, China.E-mail:baobaolaogong1211@163.com.
3. Department of Hematology, Haiyang Municipal People's Hospital, Haiyang 265100, Shandong Province, China.
- Publication Type:Journal Article
- MeSH:
Decitabine;
therapeutic use;
Humans;
Myelodysplastic Syndromes;
drug therapy;
Prognosis;
Retrospective Studies;
Treatment Outcome
- From:
Journal of Experimental Hematology
2018;26(6):1702-1707
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To explore the clinical efficacy of decitabine for treatment of patients with myelodysplastic syndrome (MDS) and factors predicting the prognosis.
METHODS:The clinical data of 87 patients with MDS treated with decitabine were analyzed retrospectively. The hENT1 mRNA expression and TP53 gene mutation were detected by Q-PCR and gene target sequencing, respectively. The relationship of clinical characteristics and molecular indicators with the clinical response to decitabine was analyzed.
RESULTS:In treatment for median 4 (2-17) courses, a total 51 patients (58.6%) showed therapeutic responses, including CR in 17 cases, PR in 12 cases, mCR in 9 cases, HI in 13 cases; 36 (41.4%) patients showed non-response. Univariate analysis showed that the patients with the complex karyotype, monosomal karyotype, chomosome 7 abnormality and Plt count doubling after 1 course treatment had a high CR rate, while the patients with relative high risk by IPSS (intermediate risk 2+ high risk), complex karyotype and Plt count doubling after 1 course had much more high overall remission rate (ORR). The expression level of hENT1 mRNA in MDS patients with response was significantly higher than that in patients without response ［(1.78±1.45 (2) vs 0.96±0.97 (2)(P= 0.002)］. Among 51 patients with therapeutic response, the expression level of hENT1 mRNA in CR group was higher than that in non-CR group ［(2.58±1.44 (2) vs 1.39 ±1.3 (2), P= 0.005)］. Among 52 patients in relative high risk (intermediate risk 2 +high risk), the median OS time of patients with high hENT1 mRNA expression was significantly longer than that of patients with low hENT1 mRNA expression (31 vs 12 months)(P<0.001). Among 87 patients received decitabine treatment, the TP53 gene mutation occured in 11 (12.6%) patients. The ORR in patients with TP53 mutation was high (P=0.04), moreover the patients with TP53 mutation more easily gained CR (P<0.001). Multivariate logistic regression model showed that the complex karyotype, Plt count doubling after 1 course treatment, TP53 mulation and high expression of hENT1 mRNA were the independent prognostic factors for predicting the CR after decitabine treatment.
CONCLUSION:IPSS staging, complex karyotype, Plt count doubling after 1 course treatment and hENT1 mRNA expression, TP53 gene mutation can be used to predict the tharapeutic efficacy of dectitabine for treatment of MDS.
