[Predict response to decitabine in patients with myelodysplastic syndrome and related neoplasms]

Role Of TP53 mutations in predicting the clinical efficacy of hypomethylating therapy in patients with myelodysplastic syndrome and related neoplasms: a systematic review and meta-analysis

Hypomethylating agents (HMAs) are now a major treatment option for myelodysplastic syndrome (MDS) and related neoplasms, but 50% of patients still do not respond and realize poor outcomes. Mutational predictors of treatment efficacy attract continuous attention. Whether TP53 mutations can be used as predictors of HMA effectiveness has caused heated debate. Therefore, we performed a meta-analysis to investigate the predictive value of TP53 mutations to outcomes of HMA therapy in patients with MDS and related neoplasms. We systematically searched PubMed, Embase, the Cochrane Library, and the WanFang databases (published deadline: September 12, 2019). The primary endpoints were overall response rate (ORR) and overall survival (OS). Odds ratio (OR), hazard ratio (HR), and 95% confidence intervals (CI) were pooled to estimate the association between TP53 mutations and the clinical efficacy of HMAs. Four hundred fifteen papers were found, and 22 papers were included in this meta-analysis (N = 2020 participants). The results showed that the presence of TP53 mutation predicted an increased overall response rate with HMA treatment in the subsets that restricted patients in de novo disease, MDS by WHO (World Health Organization) criteria, or NGS (next-generation sequence) group (P = 0.005, P = 0.003, P = 0.0005, respectively). However, TP53 mutations remained poor factors for OS (P < 0.00001). Collectively, in HMA therapy, TP53 mutations can predict better ORR when setting more refined subgroups, but TP53 mutations still strongly correlated with poor survival in hypomethylating therapy.

[Changes of WT1 mRNA expression level in patients with myelodysplastic syndromes after hypomethylating agents and its prognostic significance]

目的

监测骨髓增生异常综合征（MDS）患者去甲基化治疗后WT1 mRNA水平的变化，评估WT1 mRNA水平变化在判断患者疗效、区分不同疾病稳定（stable disease, SD）状态中的意义。

方法

以2009年11月至2018年3月56例在广东省人民医院接受去甲基化治疗（≥4个疗程）的MDS患者为研究对象，实时定量PCR检测其骨髓或外周血WT1 mRNA的表达，观察WT1 mRNA表达水平的动态变化与患者临床疗效和预后的相关性。

结果

去甲基化治疗3个疗程后，MDS患者WT1 mRNA水平较治疗前显著降低。20例疾病进展患者病情进展或转为急性髓系白血病（AML）后WT1 mRNA表达水平较治疗前明显升高。45例SD的MDS患者，根据SD期间WT1 mRNA表达水平变化分为WT1升高与未升高两组，SD期间WT1 mRNA表达水平升高的患者中病情进展或转AML的比例为95.65%（22/23），而SD期间WT1 mRNA表达水平未升高的患者中病情进展或转为AML的比例为9.09%（2/22）（χ²=33.852，P<0.001）。与SD期间WT1 mRNA表达水平未升高的患者相比，SD期间WT1 mRNA表达水平升高的患者的总生存期[17（95%CI 11~23）个月对未达到，P<0.001]和无进展生存期[13（95%CI 8~18）个月对未达到，P<0.001]明显缩短。

结论

WT1 mRNA表达水平是评估MDS患者去甲基化治疗后疗效变化有效的实验室指标，尤其对于SD的患者，动态检测WT1 mRNA表达水平，可预测病情演变，从而指导临床治疗。