Objective: To investigate the effects of decitabine (DEC) combined with all-trans retinoic acid (ATRA) on the number of immune cells, efficacy and adverse reactions in the treatment of myeloid neoplasms patients.
Methods: Eighty-four patients with myeloid tumors, including AML, MDS-EB-1 or MDS-EB-2 treated by the regimen containing decitabine in our hospital from January 2009 to October 2019 were enrolled and retrospectively analyzed, among the patients, 21 patients treated with DEC alone, 24 patients treated with DEC combined with ATRA (DEC/ATRA) and 39 patients treated with DEC combined with G-CSF priming regimen (DEC/priming). The changes of peripheral blood immune cell levels before and after treatment of the patients between the three groups were compared, and the differences in clinical efficacy and adverse reactions of the patients between the three groups were also compared.
Results: There was no statistical differences in the number of immune cells among the patients in the three groups before treatment (P>0.05). NK cell levels decreased significantly in the patients in DEC and DEC/ATRA group after treatment (P<0.05); After treatment, the levels of CD8+ and CD3+T cells in the patients treated by DEC /priming regimen significantly increased (P<0.05), while the levels of CD3-HLA-DR+ B cells significantly decreased (P<0.05). The overall response rate (ORR) of the patients in DEC/ATRA group (75%) and DEC/priming group (74.36%) was significantly higher than 42.86% in DEC monotherapy group, and the differences showed statistically significant (P<0.05), while the ORR between the patients in DEC/ATRA and DEC/priming group showed no statistic differences (P>0.05). There were no statistical differences in overall survival (OS) and incidence of bleeding between the patients in the three groups (P>0.05). The incidences of grade 3 to 4 bone marrow suppression and the infection rate of the patients in DEC monotherapy and DEC/ATRA group were significantly lower than that in DEC/priming regimen group after treatment (all P<0.05), however, there was no statistical difference between DEC monotherapy and the DEC/ATRA group.
Conclusion: The efficacy of DEC/ATRA on myeloid neoplasms is comparable to that of DEC/priming regimen, and the anti-myeloid tumor effect of DEC/ATRA regimen may be related to the regulation of NK cells and T cells.
题目: 地西他滨联合全反式维甲酸治疗髓系肿瘤患者 免疫细胞水平变化的研究.
目的: 探讨地西他滨（DEC）联合全反式维甲酸（ATRA）治疗髓系肿瘤患者过程中，免疫细胞数量变化及疗效与安全性.
方法: 选取并回顾性分析2009年1月至2019年10月于常州市第一人民医院住院接受DEC治疗的髓系肿瘤患者84例，包括急性髓系白血病（AML）、骨髓增生异常综合征伴原始细胞增多（MDS-EB-1或MDS-EB-2），其中DEC单药组21例、DEC联合ATRA组24例及DEC联合预激方案组39例。比较3组患者治疗前后外周血免疫细胞水平的变化、临床疗效及不良反应差异.
结果: 3组患者治疗前免疫细胞数量比较无统计学差异（P>0.05）。DEC单药组及DEC联合ATRA组患者治疗后NK细胞水平明显下降（P<0.05），DEC联合预激方案组患者治疗后CD8+及CD3+T细胞水平明显上升，而CD3-HLA-DR+的B细胞水平下降，且上述差异均有统计学意义（P<0.05）。DEC联合ATRA组及DEC联合预激组的总体有效率（ORR）分别为75%和74.36%，均显著高于DEC单药组的42.86%（P<0.05），而DEC联合ATRA组与DEC联合预激组的ORR无统计学差异（P>0.05）。3组患者OS无统计学差异（P>0.05）。3组患者治疗后出血发生率均无统计学差异（P>0.05）。DEC单药组及DEC联合ATRA组治疗后3-4级骨髓抑制发生率及感染率明显低于DEC联合预激组（P<0.05），而DEC单药组与DEC联合ATRA组治疗后3-4级骨髓抑制发生率及感染率无统计学差异.
结论: DEC联合ATRA方案治疗髓系肿瘤的疗效与DEC联合预激方案相当，其抗髓系肿瘤的作用可能与其对NK细胞及T细胞的调控有关.
Keywords: all-trans retinoic acid; decitabine; immune cells; myeloid neoplasms.