title: Decitabine priming prior to low-dose chemotherapy improves patient outcomes in myelodysplastic syndromes-RAEB: a retrospective analysis vs. chemotherapy alone.
abstract: OBJECTIVE
  The aim of this study was to examine whether decitabine priming prior to low-dose chemotherapeutic regimens could improve outcomes in patients with myelodysplastic syndromes-refractory anemia with excess of blasts (MDS-RAEB).
  
  
  METHODS
  The current retrospective analysis included all MDS-RAEB patients receiving idarubicin/cytarabine (IA) or aclacinomycin/cytarabine (AA), with or without decitabine priming during a period from February 2010 to May 2015. Treatment response and toxicity were compared between patients receiving decitabine priming and those who did not. A panel of 6 MDS-related genes was examined using bone marrow specimens.
  
  
  RESULTS
  A total of 81 patients were included in the analysis: 40 received decitabine priming prior to chemotherapy (decitabine priming group). The median follow-up was 10.9 months (IQR: 6.2-21.9). The rate of overall response (OR) and complete remission (CR) was significantly higher in the decitabine priming group than in the chemotherapy group (OR: 75.0 vs. 51.2%, p = 0.027; CR: 55.0 vs. 29.3%, p = 0.019). Overall survival (OS) did not differ significantly between the two groups (19.5 vs. 14.7 months, p = 0.082). In a subgroup analysis that included only patients at < 60 years of age, the CR rate in the decitabine priming group was significantly higher than in the chemotherapy group (65.5 vs. 31.0%, p = 0.009). Survival benefit of decitabine priming was apparent in patients at < 60 years of age (22.4 months with 95% CI of 6.7-38.1 vs. 14.7 months with 95% CI of 11.4-18.0 months in the chemotherapy group, p = 0.028), patients with intermediate and unfavorable karyotypes (22.4 months with 95% CI of 15.1-29.7 vs. 11.9 months with 95% CI of 4.0-19.8 months in the chemotherapy group, p = 0.042), and patients with mutated splicing factor genes (35.3 months with 95% CI of 21.4-49.2 vs. 17.8 months with 95% CI of 13.8-21.8 months in the chemotherapy group, p = 0.039). Grade 3-4 hematological and non-hematological toxicities were not significantly different between the two groups.
  
  
  CONCLUSIONS
  Decitabine priming prior to low-dose chemotherapy could improve treatment responses in patients with MDS-RAEB.
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.|Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.
authors.forename: Li
authors.initials: L
authors.lastname: Ye
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.|Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.
authors.forename: Yanling
authors.initials: Y
authors.lastname: Ren
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.|Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.
authors.forename: Xinping
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.|Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Mei
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.|Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.
authors.forename: Liya
authors.initials: L
authors.lastname: Ma
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.|Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Department of Hematology, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, 322000, Zhejiang, China.
authors.forename: Xingnong
authors.initials: X
authors.lastname: Ye
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.
authors.forename: Juying
authors.initials: J
authors.lastname: Wei
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.
authors.forename: Weilai
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.
authors.forename: Haitao
authors.initials: H
authors.lastname: Meng
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.
authors.forename: Wenbin
authors.initials: W
authors.lastname: Qian
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.
authors.forename: Wenyuan
authors.initials: W
authors.lastname: Mai
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.
authors.forename: Yinjun
authors.initials: Y
authors.lastname: Lou
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.
authors.forename: Gaixiang
authors.initials: G
authors.lastname: Xu
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.
authors.forename: Jiejing
authors.initials: J
authors.lastname: Qian
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.
authors.forename: Yejiang
authors.initials: Y
authors.lastname: Lou
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.|Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.
authors.forename: Yingwan
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.|Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.
authors.forename: Lili
authors.initials: L
authors.lastname: Xie
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.|Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.
authors.forename: Peipei
authors.initials: P
authors.lastname: Lin
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.|Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Hu
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Jin
authors.affiliation: Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China. zjuhongyantong@163.com.|Institute of Hematology, Zhejiang University, Hangzhou, 310009, Zhejiang, China. zjuhongyantong@163.com.|Myelodysplastic Syndromes Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China. zjuhongyantong@163.com.
authors.forename: Hongyan
authors.initials: H
authors.lastname: Tong
mesh_terms: D015250:Aclarubicin / Q000008:administration & dosage / Q000031:analogs & derivatives; D000328:Adult; D000754:Anemia, Refractory, with Excess of Blasts / Q000188:drug therapy* / Q000235:genetics; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001374:Azacitidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D003561:Cytarabine / Q000008:administration & dosage; D000077209:Decitabine; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D059785:Karyotype; D008297:Male; D008875:Middle Aged; D009154:Mutation; D012189:Retrospective Studies
chemical_list: C011157:aclacinomycins; D003561:Cytarabine; D015250:Aclarubicin; D000077209:Decitabine; D001374:Azacitidine; D015255:Idarubicin
keywords: Chemotherapy; Decitabine; Myelodysplastic syndromes