Clinical Study on the Treatment of Acute Myeloid Leukemia in the Elderly with the Huangqi Decoction Combined with Decitabine and CAG Regimen

  OBJECTIVE  To study the clinical efficacy and possible mechanism of the additional Huangqi Decoction on treating acute myeloid leukemia (AML) in the elderly.

  METHODS  A total of 132 elderly AML inpatients admitted to Hebei province hospital of Chinese medicine from January 2018 to July 2021 were randomly divided into the control group and the treatment group of 66 cases each. The control group was treated with Decitabine combined with conventional CAG regimen, while the treatment group was given with Huangqi Decoction based on the therapies in the control group. After treatment, we observed the clinical efficacy, supportive treatment, and occurrence of adverse reactions in both groups. In addition, we measured the changes of mRNA expression levels of immune function indexes (CD3⁺, CD4⁺, CD8⁺, IgG, IgA, IgM) and apoptosis-related indexes (Bcl-2, Bax, Bak, Bcl-xl) before and after treatment in the two groups.

  RESULTS  After treatment, the total effective rate of the treatment group was higher than that of the control group (P < 0.01), and the incidence of supportive treatment and adverse reactions was lower than that of the control group (P < 0.05, P < 0.01). The proportion of CD3⁺, CD4⁺ and CD8⁺ cells and the levels of IgG, IgA and IgM in both groups were significantly reduced (P < 0.01), while the proportion of CD3⁺, CD4⁺ and CD8⁺ cells in the treatment group was lower than that of the control group (P < 0.01). In addition, Bcl-2 and Bcl-xl mRNA expression levels were significantly reduced (P < 0.01), but Bax and Bak mRNA expression levels were significantly increased in the treatment group (P < 0.01). In comparison, only Bcl-2 mRNA expression levels were significantly reduced (P < 0.01) and Bax mRNA expression levels were significantly increased in the control group (P < 0.01). On top of that, Bcl-2 and Bcl-xl mRNA expression levels were lower in the treatment group than in the control group, but Bak mRNA expression levels were higher in the treatment group than in the control group (P < 0.01). Logistic regression analysis showed that the independent risk factors affecting the prognosis of elderly AML patients mainly included age, non-use of Huangqi Decoction combined with Decitabine treatment, low immune function, as well as adverse reactions (P < 0.01).

  CONCLUSION  Huangqi Decoction combined with Decitabine and CAG regimen can remarkably improve the clinical efficacy of elderly AML patients and improve the body's immune function indexes. Thus, the mechanism may be related to the regulation of apoptosis-related factor expression.