This study was purposed to investigate the clinical efficiencies and adverse reactions of treating the myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) by using decitabine. The clinical data of 12 MDS and AML patients treated with decitabine were analyzed retrospectively. Among 12 patients there were 1 case of MDS-RA, 2 cases of MDS-RAEB-Ⅰ , 3 cases of MDS-RAEB- Ⅱ , 2 cases of AML-M4, 2 cases of AML-M5, 1 case of AML-M6 and 1 case of AML-M0. In decitabine chemotherapy program for 5 days (n = 8), decitabine 20 mg/ (m2 · d) × 5 days was applied, 4 weeks for 1 cycle; in program for 3 days (n = 2), decitabine 15 mg / m2, once 8 h for 3 days, 6 weeks for 1 cycle; another program (n = 2), decitabine 20 mg/ (m2 · d) every other day for 5 times. For 1 patient achieved complete remission (CR) after treatment with decitbine, ID4 gene methylated level was detected by MS-PCR and ML-PCR before and after treatment. The results showed that 2 cases achieved CR, 1 case partial remission, 5 cases stable disease, 1 case progress of disease and 3 cases died. Disease control rate was 66. 67% (8/ 12), the effective rate 25% (3/12). The average survival time was (11.5 ±2.1) months. 1 -year OS rate was 40% , 2-year OS rate was 16. 7%. MS-PCR detection showed that the decitabine could significantly reduce the ID4 gene methylation level. It is concluded that decitabine can stablize disease status of MDS patients, reduce blood transfusion dependence and improve the life quality of patients, and even some patients who transformed from MDS to leukemia achieved CR after treatment with decitabine. Decitabine can reduce the ID4 gene methylation level. The main adverse reaction of decitabine was myelosuppression, infection and so on. So the blood transfusions, antibiotics and other supportive treatments for these patients are needed. Most of patients well tolerate the adverse effects of decitabine after active symptomatic and supportive treatment. The efficacy and survival rate of patients in this study were similar to that of application of decitabine to treat MDS in other domestic studies.%本研究目的是观察地西他滨治疗骨髓增生异常综合征(MDS)和急性髓系白血病(AML)的临床疗效及不良反应.对2009年11月至2011年12月我科收治的应用地西他滨治疗的12例MDS及AML患者进行了回顾性分析.12例中1例MDS-RA,2例MDS-RAEB-Ⅰ,3例MDS-RAEB-Ⅱ,2例AML-M4,2例AML-M5,1例AML-M6,l例AML-M0.8例应用地西他滨化疗5d方案:地西他滨20 mg/(m2.d)×5 d,4周为1个周期；3例用3d方案:地西他滨15 mg/m2,1次/8 h×3d,6周为1个周期；另2例用地西他滨20 mg/m2,隔日1次×5次.应用甲基化特异性聚合酶链反应(MS-PCR)检测1例应用地西他滨治疗后达到完全缓解(CR)患者治疗前后ID4基因甲基化表达水平,进一步验证地西他滨的去甲基化作用.结果显示,12例患者中CR 2例、部分缓解1例、病情稳定5例、病情进展l例、死亡3例.疾病控制率66.67％ (8/12),有效率25％(3/12).患者的平均生存期为(11.5±2.1)个月、1年总体生存(OS)率为40％、2年OS率为16.7％.MS-PCR检测显示,地西他滨使ID4基因甲基化水平明显降低.结论:地西他滨能够使MDS患者病情稳定,减轻输血依赖,提高生活质量,甚至能够使部分MDS向白血病转化的患者达到完全缓解.地西他滨能够使ID4基因甲基化水平明显降低.其不良反应主要为骨髓抑制和感染,需输血抗感染等支持治疗,部分患者经积极对症支持治疗可以耐受.本研究中的疗效及生存期与国内研究相类似.
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