Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Compostos Bicíclicos Heterocíclicos com Pontes/efeitos adversos , Leucemia Mieloide Aguda/tratamento farmacológico , Sulfonamidas/efeitos adversos , Síndrome de Lise Tumoral/etiologia , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Compostos Bicíclicos Heterocíclicos com Pontes/administração & dosagem , Citarabina/uso terapêutico , Decitabina/administração & dosagem , Feminino , Hidratação , Humanos , Hidroxiureia/uso terapêutico , Incidência , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/genética , Leucemia Mielomonocítica Aguda/complicações , Leucemia Mielomonocítica Aguda/tratamento farmacológico , Leucemia Mielomonocítica Aguda/genética , Leucocitose/tratamento farmacológico , Leucocitose/etiologia , Masculino , Pessoa de Meia-Idade , Proteínas de Ligação a Fosfato/uso terapêutico , Fósforo/sangue , Proteínas Proto-Oncogênicas c-bcl-2/antagonistas & inibidores , Estudos Retrospectivos , Sulfonamidas/administração & dosagem , Urato Oxidase/uso terapêutico , Ácido Úrico/sangueRESUMO
In acute myeloid leukemia (AML), myelodysplasia-related changes contribute to a poor prognosis. This retrospective, propensity score-matched study analyzed 108 newly diagnosed AML patients with features of myelodysplasia syndrome (MDS) (aged 14-60 years) from 2014 to 2018, who received either idarubicin and cytarabine (IA) or decitabine, idarubicin and cytarabine (DAC+IA), and compared efficacy and toxicity between the two regimens. After propensity score matching, there were 54 patients in each group. The rate of complete remission (CR) was higher in the DAC+IA group than in the IA group (85.2% vs 68.5%, P = .040) after the first course, and toxicities were comparable in both groups. Multivariate analysis indicated that the combination with DAC was independent factor for CR rate after the first induction therapy (OR = 2.978, 95% CI:1.090-8.137, P = .033). Subgroup analysis showed a CR advantage for DAC+IA (vs IA) for patients of intermediate-high risk status according to National Comprehensive Cancer Network prognostic stratification. In conclusion, DAC+IA is therefore offered as a new induction choice for newly diagnosed AML patients with features of MDS, aged <60 years old, especially in intermediate-high risk status.