Efficacy and safety of decitabine in treatment of elderly patients with acute myeloid leukemia: A systematic review and meta-analysis
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Pin-Fang He1,2,*, Jing-Dong Zhou4,*, Dong-Ming Yao3,*, Ji-Chun Ma1,2, Xiang-Mei Wen1,2, Zhi-Hui Zhang4, Xin-Yue Lian4, Zi-Jun Xu1,2, Jun Qian4 and Jiang Lin1,2
1Laboratory Center, Affiliated People’s Hospital of Jiangsu University, Zhenjiang 212002, Jiangsu, P.R. China
2The Key Lab of Precision Diagnosis and Treatment of Zhenjiang City, Zhenjiang 212002, Jiangsu, P.R. China
3Department of Clinical Laboratory, Affiliated People’s Hospital of Jiangsu University, Zhenjiang 212002, Jiangsu, P.R. China
4Department of Hematology, Affiliated People’s Hospital of Jiangsu University, Zhenjiang 212002, Jiangsu, P.R. China
*These authors contributed equally to this work
Jiang Lin, email: firstname.lastname@example.org
Jun Qian, email: email@example.com
Keywords: acute myeloid leukemia (AML), decitabine, elderly patient, systematic review, meta-analysis
Received: December 08, 2016 Accepted: April 11, 2017 Published: April 19, 2017
Elderly patients with acute myeloid leukemia (AML) have limited treatment options concerned about their overall fitness and potential treatment related mortality. Although a number of clinical trials demonstrated benefits of decitabine treatment in elderly AML patients, the results remains controversial. A meta-analysis was performed to evaluate efficacy and safety of decitabine in treatment of elderly AML patients. Eligible studies were identified from PubMed, Web of Science, Embase and Cochrane Library. Nine published studies were included in the meta-analysis, enrolling 718 elderly AML patients. The efficacy outcomes were complete remission (CR), overall response rate (ORR) and overall survival (OS). Safety was evaluated based on treatment related grades 3–4 adverse events (AEs) and early death (ED) rate. Pooled estimates with 95% confidence interval (CI) for CR, ORR and OS were 27% (95% CI 19%–36%), 37% (95% CI 28%–47%) and 8.09 months (95% CI 5.77–10.41), respectively. The estimated treatment related early death (ED) incidences were within 30-days 7% (95% CI 2%–11%) and 60-days 17% (95% CI 11%–22%), respectively. Thrombocytopenia was the most common grades 3–4 AEs. Subgroup analyses of age, cytogenetics risk, AML type and bone marrow blast percentage showed no significant differences of treatment response to decitabine. In conclusion, decitabine is an effective and well-tolerated therapeutic alternative with acceptable side effects in elderly AML patients.
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