[The Relationship Between Serum CysC, β2-MG and the Efficacy of Demethylation Therapy in Patients with Acute Myeloid leukemia].

Objective: To analyze the relationship between serum cystatin C (CysC), β₂-microglobulin (β₂-MG) and the efficacy of demethylation therapy in patients with acute myeloid leukemia (AML).

Methods: A prospective cohort study was conducted on 98 AML patients admitted to the Affiliated Hospital of Inner Mongolia Medical University from February 2019 to January 2022. All patients were treated with decitabine (DAC) + HAG regimen, 28 days as a course and treated for 3-4 courses. At the end of each course of treatment, the treatment effect of the patients was evaluated, and the patients who achieved complete remission (CR) transferred to consolidation therapy, while the patients who did not reach CR at the end of the course of treatment were considered as treatment failure. The examination items before treatment include routine blood parameters, serum CysC, and β₂-MG, and general clinical data of the patients were collected. According to the statistical results, logistic regression model was used to analyze the relationship between serum CysC, β₂-MG and the efficacy of demethylation therapy in AML patients. The ROC curves were drawn, and the predictive efficacy of serum CysC, β₂-MG on demethylation therapy in AML patients was evaluated by the area under the curve (AUC).

Results: Of the 98 AML patients enrolled in the study, 5 cases were excluded during the treatment period, and 93 cases finally completed the chemotherapy courses. Among them, 23 patients achieved CR after the initial induction chemotherapy (course 1-2), and 11 patients achieved CR after the re-induction chemotherapy (course 3-4). The success rate of demethylation therapy was 36.56 % (34/93). Compared with the patients in treatment success group, patients in treatment failure group had a higher proportion of intermediate- and adverse-risk, lower levels of platelet (PLT) and hemoglobin (Hb), and higher expression levels of serum CysC and β₂-MG, all of which were statistically significant (P < 0.05). Logistic regression analysis showed that high expression of serum CysC, β₂-MG and adverse-risk were independent risk factors for failure of demethylation treatment in AML patients (OR >1, P < 0.05). The ROC curves showed that the AUC values of serum CysC, β₂-MG alone and combined in predicting the efficacy of demethylation therapy in AML patients were 0.788, 0.785 and 0.834, respectively.

Conclusion: The failure of demethylation therapy in AML patients is related to the high expression of serum CysC and β₂-MG, and detection of serum CysC and β₂-MG before treatment can predict the risk of demethylation therapy failure in AML patients.