Meta-analysis of clinical efficacy and safety of decitabine combined with CAG regimen in the treatment of acute myeloid leukemia in the elderly.

OBJECTIVE: To systematically evaluate the clinical efficacy and safety of decitabine (DAC) combined with CAG regimen in the treatment of elderly patients with acute myeloid leukemia (AML) using meta-analysis.

METHODS: The studies reported the clinical efficacy and safety of DAC combined with CAG regimen in the treatment of elderly AML patients were searched in Pubmed, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP database by computer. On the basis of the screening criteria, the non-conforming literature was eliminated and the final selected literature was analyzed. The methodological quality was assessed and the research data was extracted. Revman 5.3 software was used to assess the clinical efficacy and safety of DAC combined with CAG in the treatment of elderly AML patients, which were shown with forest map. The funnel plots were used to test publication bias.

RESULTS: Thirteen studies involving 1133 elderly AML patients were included. ‌Meta-analysis demonstrated that‌ in comparison with CAG alone group, the CR rate (Z = 5.50, P < 0.001) and total effective rate (Z = 8.71, P < 0.001) of DAC combined with CAG group were higher, while there was no significant difference in PR rate between the two groups (Z = 1.59, P = 0.11). And the infection rate (Z = 3.56, P < 0.001) and fever rate (Z = 5.86, P < 0.001) of DAC combined with CAG group were increased. There were no significant differences in the rates of hematological adverse reactions (P = 0.14), gastrointestinal reactions (P = 0.05), alopecia (P = 0.39), heart injury (P = 0.55), liver and kidney injury (P = 0.74) and myelosuppression (P = 0.82) between the two groups.

CONCLUSION: Compared with CAG alone regimen, DAC combined with CAG regimen improves clinical efficacy in elderly AML patients, but increases risks of infection and fever-related adverse events.