A favorable inductive remission rate for decitabine combined with chemotherapy as a first course in <60-year-old acute myeloid leukemia patients with myelodysplasia syndrome features

Identification of Signature Genes and Construction of an Artificial Neural Network Model of Prostate Cancer

This study aimed to establish an artificial neural network (ANN) model based on prostate cancer signature genes (PCaSGs) to predict the patients with prostate cancer (PCa). In the present study, 270 differentially expressed genes (DEGs) were identified between PCa and normal prostate (NP) groups by differential gene expression analysis. Next, we performed Metascape gene annotation, pathway and process enrichment analysis, and PPI enrichment analysis on all 270 DEGs. Then, we identified and screened out 30 PCaSGs based on the random forest analysis and constructed an ANN model based on the gene score matrix consisting of 30 PCaSGs. Lastly, analysis of microarray dataset GSE46602 showed that the accuracy of this model for predicating PCa and NP samples was 88.9 and 78.6%, respectively. Our results suggested that the ANN model based on PCaSGs can be used for effectively predicting the patients with PCa and will be helpful for early PCa diagnosis and treatment.

Efficacy and Safety of Homoharringtonine for the Treatment of Acute Myeloid Leukemia: A Meta-analysis

BACKGROUND

To evaluate the efficacy and safety of homoharringtonine (HHT) in acute myeloid leukemia (AML).

METHODS

PubMed, Cochrane Library, Embase, China National Knowledge of Infrastructure, and Wanfang data were systematically searched until October 31, 2020, for AML treatment with and without HHT. Fixed- and random-effect models were used to pool main outcomes, and between-study heterogeneity was assessed.

RESULTS

A total of 37 articles (2846 patients) fitting our criterion were included. The pooled overall response rate for the patients treated with HHT was 82% (CI, 77.9%-85.6%; I² = 73.5%), and the complete response rate was 63.4% (CI, 58.8%-68%; I² = 67.3%). Our study showed that patients treated with HHT have more overall response and complete response benefits and less cardiotoxicity and relapse rate. Subgroup analysis showed that patients with AML treated with HHT have significant overall response benefits in patients younger than 60 (odds ratio [OR], 1.63; CI, 1.33-2; I² = 1.7%; P < .001), the newly diagnosed (OR, 1.59; CI, 1.15-2.21; I² = 34.7%; P = .006), and relapsed/refractory patients (OR, 2.13; CI, 1.38-3.29; I² = 32.3%; P = .001). Better complete remission benefits were observed in patients younger than 60 (OR, 1.32; CI, 1.1-1.59; I² = 7%; P = .004), the newly diagnosed (OR, 1.32; CI, 1.08-1.62; I² = 33.5%; P = .006), and relapsed/refractory patients (OR, 1.81; CI, 1.19-2.77; P = .006). For elderly patients, HHT treatment reduced relapse risk by 76.6% (OR, 0.23; CI, 0.09-0.63; I² = 0%; P = .004).

CONCLUSIONS

HHT can be a reliable choice with less cardiotoxicity for patients with AML, especially for the newly diagnosed or patients younger than 60. For elderly intolerant patients, the use of HHT can reduce relapse.

Clinical Characteristics and Optimal Therapy of Acute Myeloid Leukemia with Myelodysplasia-Related Changes: A Retrospective Analysis of a Cohort of Chinese Patients

Objective:

This study aimed to investigate the clinical characteristics of acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) according to the 2016 World Health Organization classification and the preferred therapy for patients with AML-MRC aged 60-75 years.

Materials and Methods:

We retrospectively analyzed differences in clinical data among 190 patients with AML-MRC and 667 patients with AML not otherwise specified (AML-NOS). We also compared different therapeutic regimens among patients with AML-MRC aged 60-75 years.

Results:

Compared with AML-NOS, patients with AML-MRC had significantly different clinical characteristics as well as worse overall survival (OS) (9.2 vs. 13.6 months; p<0.001) and complete remission rates (65.3% vs. 76.2%; p=0.005). Multivariate analysis performed for the whole group (patients with both AML-MRC and AML-NOS) showed that AML-MRC was the independent prognostic factor (p=0.002). Additional multivariate analysis performed for 190 patients with AML-MRC indicated that age (p<0.001) and lactate dehydrogenase (p=0.031) were independent prognostic factors. Compared with the IA/DA regimen [idarubicin and cytarabine (IA) or daunorubicin and cytarabine (DA)], the DAC+CAG regimen [decitabine and half-dose CAG regimen (cytarabine, aclarubicin, and granulocyte colony-stimulating factor)] was associated with better OS (4.5 vs. 6.2 months; p=0.021) in patients aged 60-75 years and categorized into the unfavorable risk group.

Conclusion:

AML-MRC cases exhibited worse clinical outcomes compared to AML-NOS. Compared to the IA/DA regimen, the DAC+CAG regimen was the optimal choice for patients with AML-MRC in the unfavorable risk group and aged 60-75 years.

The efficacy and safety of daunorubicin versus idarubicin combined with cytarabine for induction therapy in acute myeloid leukemia: A meta-analysis of randomized clinical trials

OBJECTIVE

To ascertain the efficacy and safety of daunorubicin combined with cytarabine comparing with idarubicin combined with cytarabine as a standard induction therapy for acute Myeloid leukemia by a meta-analysis.

METHODS

The randomized controlled trials included were retrieved from PubMed, Embase, and Cochrane library. We evaluated and cross-checked the randomized clinical trials (RCTs) comparing daunorubicin combined with cytarabine (DA) and idarubicin combined with cytarabine (IA) by two reviewers independently according to Cochrane Handbook for Systematic Reviewers of Interventions. The data of meta-analysis was conducted using Review Manager 5.3 and Stata 12.0 software.

RESULTS

A total of 6 studies containing 3140 patients were included. The primary outcomes were complete remission (CR), CR in one course (CR1), CR in two courses (CR2), overall survival (OS), and relapse rate. The secondary outcomes included adverse events and cytogenetic risk in subgroup analyses. IA showed a statistically significant in CR (RR = 1.05; 95%CI = 1.00-1.09, P = .03) and CR1 (RR = 1.11; 95%CI = 1.04-1.18, P = .003), but not in CR2 (RR = 0.97; 95%CI = 0.77-1.24, P = .83), and relapse rate (RR = 1.08; 95%CI = 0.98-1.43, P = .08). In high dose daunorubicin group, OS was significantly improved with IA compared to DA (HR = 0.89, 95%CI = 0.8-1.0, P = .041, I = 0). At grade 3/4 adverse events, the difference between IA and DA was not statistically significant (infection, P = .28; cardiac toxicity, P = .15; bleeding, P = .29). In the subgroup analysis, the genotypes of the IA and DA groups were not statistically significant for comparison of CR between the two groups (P = .07).

CONCLUSION

This meta-analysis showed that IA had a better efficacy in the treatment of acute myeloid leukemia than DA, even with increased doses of DA. The OS of a standard dose of IA patients was longer than that of DA patients. Our research shows that anthracycline dose intensification of daunorubicin is of no clinically relevant benefit in AML patients comparing with a standard dose of IA. When it comes to adverse drug reactions, it is not a significant difference. Therefore, in clinical practice, IA should be the first choice for induction regimen in patients with acute myeloid leukemia.

A favorable inductive remission rate for decitabine combined with chemotherapy as a first course in <60-year-old acute myeloid leukemia patients with myelodysplasia syndrome features

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.