A comparison of therapeutic dosages of decitabine in treating myelodysplastic syndrome: a meta-analysis

Decitabine is used to treat myelodysplastic syndrome (MDS). This meta-analysis evaluated the efficacy and safety of different dosing regimens of decitabine in treating intermediate and/or high-risk MDS. Medline, Cochrane, EMBASE, and Google Scholar databases were searched up to October 23, 2015. Randomized controlled trials, prospective, cohort, and case series studies were included. Fifteen studies were included with a total of 1378 patients. The decitabine 100 mg/m²/course dosing regimen had a greater overall response rate than the 60–75 mg/m²/course (51 vs. 25%; P = 0.003). It also had higher complete response rate compared with the 135 mg/m²/course regimen (24.2 vs.13.7%; P = 0.016). The three dosing regimens were similar with respect to bone marrow complete response and partial response and hematologic improvement (P values > 0.05). Decitabine 135 mg/m²/course regimen had similar hematologic improvement as best supportive care (P = 0.066). The incidence of neutropenia, thrombocytopenia, infections, and anemia was similar across treatment groups (range, 31 to 38%; P values ≥ 0.899). The 100 mg/m²/course decitabine regimen showed benefit with respect to overall response rate compared with the 60–75 mg/m²/course regimen, as well as greater improvement in complete response rate compared with the 135 mg/m²/course regimen. All three dosing regimens had similar frequency of adverse events.