Effect of add-on therapy with Traditional Chinese Medicine on the survival of patients with anemic lower-risk myelodysplastic syndromes in the real-world setting: a retrospective study

doi:10.19852/j.cnki.jtcm.2025.01.014

Journal of Traditional Chinese Medicine ›› 2025, Vol. 45 ›› Issue (1): 152-159.DOI: 10.19852/j.cnki.jtcm.2025.01.014

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Effect of add-on therapy with Traditional Chinese Medicine on the survival of patients with anemic lower-risk myelodysplastic syndromes in the real-world setting: a retrospective study

QU Weiying¹, TAN Xyucheng¹, ZHAO Yihan¹, YU Yanan²(), ZHAO Lin³()

1 Department of Hematology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200120, China
2 Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
3 Department of Hematology and CHEN Jianjie National Famous Old Chinese Medicine Expert Inheritance Studio, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200120, China

Received:2023-06-16 Accepted:2023-12-23 Online:2025-02-15 Published:2025-01-10
Contact: ZHAO Lin, Department of Hematology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200120, China; CHEN Jianjie National Famous Old Chinese Medicine Expert Inheritance Studio, Shanghai 200120, China. sg1520@shutcm.edu.cn; YU Yanan, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China. yyn433@sina.com Telephone: +86-21-53827352
Supported by:
China Academy of Chinese Medical Sciences Innovation Fund: Precise Positioning Decision-making Platform for Clinical Trials of Traditional Chinese Medicine Based on Predicition Model(CI2021A04707);The Fundamental Research Funds for the Central Public Welfare Research Institutes: Research on Traditional Chinese Medicine Syndrome Differentiation-based a Bayesian Decision Model of Basket Trial(ZZ13-YQ-076);The Fifth Batch of National TCM Clinical Outstanding Talent Training Program. The Fund of National Natural Science Foundation of China (Youth Science Foundation Project): Effect of Compound Shenlu Granule on Apoptosis of CD34+ Cells in Lower-risk Myelodysplastic Syndromes Bone Marrow based on p38 Mitogen-activated Protein Kinase Pathway(81403233)

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Abstract

Abstract:

OBJECTIVE: To illustrate the effect of add-on therapy of Traditional Chinese Medicine (TCM) on the long-term survival of anemic lower-risk myelodysplastic syndromes (LR-MDS) patients.

METHODS: In this study, we conducted a retrospective analysis of the data of patients with LR-MDS who were identified from Shuguang Hospital between January 2006 and June 2020. The Kaplan-Meier method was used to calculate overall survival (OS), while the Cox model was employed to analyze prognostic factors of long-term survival. A total of 162 patients who met the inclusion criteria were divided into two groups: the TCM group (n = 78) or the non-TCM group (n = 84).

RESULTS: There were no significant differences in baseline characteristics. The cumulative survival rate of the TCM group was significantly higher than that of the non-TCM group [log-rank P = 0.029, hazard ratio (HR) = 0.484, 95% confidence interval (CI) (0.249, 0.942), P < 0.05]. Patients with longer TCM treatment appeared to have better OS (≥ 12 months vs < 12 months); [HR, 0.166 95% CI (0.055, 0.508), P < 0.001)]. According to the Cox model analysis, the combination of TCM and conventional Western Medicine may be a protective factor affecting the long-term survival of LR-MDS patients [HR = 0.509, 95% CI, (0.261, 0.993), P = 0.048]. The hematologic improvement erythroid response (HI-E) rate of the TCM group was significantly higher than that of the non-TCM group (69.23% vs 52.38%; P = 0.028). However, the duration of HI-E and cases of disease progression after HI-E did not significantly differ from the non-TCM group (P > 0.05).

CONCLUSIONS: The integration of TCM and Western Medicine has the potential to extend the OS of LR-MDS patients when compared to the use of Western Medicine alone.

Key words: lower-risk myelodysplastic syndromes, medicine, Chinese traditional, overall survival, retrospective studies

QU Weiying, TAN Xyucheng, ZHAO Yihan, YU Yanan, ZHAO Lin. Effect of add-on therapy with Traditional Chinese Medicine on the survival of patients with anemic lower-risk myelodysplastic syndromes in the real-world setting: a retrospective study[J]. Journal of Traditional Chinese Medicine, 2025, 45(1): 152-159.

Figures/Tables 8

References 39.

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Characteristic		TCM group (n = 78)	Non-TCM group (n = 84)	P value
Age (years, median)		51 (18, 80)	55 (20, 80)	0.204
Sex [n (%)]	Male	38 (48.72)	37 (44.05)	0.989
	Female	40 (51.28)	47 (55.95)
WHO Classification at diagnosis [n (%)]	RA	7 (8.97)	10 (11.90)	0.843
	RARS	4 (5.13)	6 (7.14)
	RCMD	57 (73.08)	62 (73.81)
	EB-1	4 (5.13)	3 (3.57)
	U	2 (2.56)	3 (3.57)
Chromosomal abnormalities [n (%)]		17 (21.79)	13 (15.48)	0.319
IPSS at diagnosis [n (%)]	Low	10 (12.82)	14 (16.67)	0.108
	Intermediate-1	68(87.18)	70 (83.33)
IPSS-R at diagnosis [n (%)]	Very low/low	38 (48.71)	40 (47.62)	1.000
	Intermediate	40 (51.28)	44 (52.38)
Peripheral blood at onset of treatment	Hb (g/L, median)	69 (31,99)	69 (40,99)	0.262
	ANC (×10⁹/L, median)	1.56 (0.42, 4.5)	1.62 (0.1, 9.18)	0.167
	Platelets (×10⁹/L, median)	30 (3, 358)	49 (3, 410)	0.630
Transfusion dependence at onset of treatment [n (%)]		37 (47.44)	48 (57.14)	0.271
Western medical treatment [n (%)]	Androgens	33 (42.31)	28 (33.33)	0.259
	Androgens+epoetin alfa	12 (15.38)	20 (23.81)	0.236
	Androgens+CsA	30 (38.46)	32 (38.10)	0.100
	Androgens+others	3 (3.85)	4 (4.76)	0.100
	Time of TCM administration (month, median)	12 (3, 120)	NA	NA

Characteristic		TCM group (n = 78)	Non-TCM group (n = 84)	P value
Age (years, median)		51 (18, 80)	55 (20, 80)	0.204
Sex [n (%)]	Male	38 (48.72)	37 (44.05)	0.989
	Female	40 (51.28)	47 (55.95)
WHO Classification at diagnosis [n (%)]	RA	7 (8.97)	10 (11.90)	0.843
	RARS	4 (5.13)	6 (7.14)
	RCMD	57 (73.08)	62 (73.81)
	EB-1	4 (5.13)	3 (3.57)
	U	2 (2.56)	3 (3.57)
Chromosomal abnormalities [n (%)]		17 (21.79)	13 (15.48)	0.319
IPSS at diagnosis [n (%)]	Low	10 (12.82)	14 (16.67)	0.108
	Intermediate-1	68(87.18)	70 (83.33)
IPSS-R at diagnosis [n (%)]	Very low/low	38 (48.71)	40 (47.62)	1.000
	Intermediate	40 (51.28)	44 (52.38)
Peripheral blood at onset of treatment	Hb (g/L, median)	69 (31,99)	69 (40,99)	0.262
	ANC (×10⁹/L, median)	1.56 (0.42, 4.5)	1.62 (0.1, 9.18)	0.167
	Platelets (×10⁹/L, median)	30 (3, 358)	49 (3, 410)	0.630
Transfusion dependence at onset of treatment [n (%)]		37 (47.44)	48 (57.14)	0.271
Western medical treatment [n (%)]	Androgens	33 (42.31)	28 (33.33)	0.259
	Androgens+epoetin alfa	12 (15.38)	20 (23.81)	0.236
	Androgens+CsA	30 (38.46)	32 (38.10)	0.100
	Androgens+others	3 (3.85)	4 (4.76)	0.100
	Time of TCM administration (month, median)	12 (3, 120)	NA	NA

Variable		TCM group (n = 78)	Non-TCM group (n = 84)
Events [n (%)]	Death	18 (23.08)	31 (36.90)
	Censor	60 (76.92)	53 (63.10)
Survival rate [% (95% CI)]	3 years	96.7 (92.2, 100)	77.9 (67.7, 88.1)
	5 years	83.5 (73.7, 93.3)	63.7 (51.0, 76.4)
	7 years	70.8 (57.5, 84.1)	58.9 (45.6, 72.2)

Variable		TCM group (n = 78)	Non-TCM group (n = 84)
Events [n (%)]	Death	18 (23.08)	31 (36.90)
	Censor	60 (76.92)	53 (63.10)
Survival rate [% (95% CI)]	3 years	96.7 (92.2, 100)	77.9 (67.7, 88.1)
	5 years	83.5 (73.7, 93.3)	63.7 (51.0, 76.4)
	7 years	70.8 (57.5, 84.1)	58.9 (45.6, 72.2)

Variable	Univariate analysis
Variable	HR (95% CI)	HR (95% CI)
Gender (female vs male)	1.091 (0.573, 2.08)	0.790
Age (≤50 vs >50)	1.386 (0.719, 2.672)	0.329
Interval from diagnosis to onset of therapy	1.000 (0.997, 1.004)	0.821
IPSS-R (≤3 vs >3)	1.285 (0.661, 2.498)	0.459
Hb (g/dL) (≤60 vs >60)	0.938 (0.483, 1.823)	0.851
Transfusion dependence at onset of treatment (Yes vs No)	1.616 (0.832, 3.142)	0.157
Androgens+TCM [n (%)]	0.772 (0.393, 1.518)	0.454
Androgens+epoetin alfa [n (%)]	0.413 (0.153, 1.408)	0.219
Androgens+CsA [n (%)]	0.771 (0.399, 1.49)	0.440
TCM group vs non-TCM group	0.484 (0.249, 0.942)	0.033

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Effect of add-on therapy with Traditional Chinese Medicine on the survival of patients with anemic lower-risk myelodysplastic syndromes in the real-world setting: a retrospective study

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References 39.

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Variable	TCM group (n = 78)	Non-TCM group (n = 84)	P value
HI-E [n (%)]	54/78 (69.23)	44/84 (52.38)	0.028
HI-N [n (%)]	10/78 (12.82)	8/84 (9.52)	0.505
HI-P [n (%)]	27/78 (34.62)	22/84 (26.19)	0.243
HI-E maintenance (months)	36 (2, 173)	36 (2, 152)	0.439
Progress after HI-E [n (%)]	25/54 (46.30)	22/44 (50.00)	0.521
RBC-TI [n (%)]	18/37 (48.65)	22/48 (45.83)	0.877

Latin name	Chinese name	Number of patients [n (%)]	Common dosage for patients (g)
Radix Codonopsis	Dangshen	74 (94.87)	10-15
Rhizoma Atractylodis Macrocephalae	Baizhu	71 (91.03)	10-15
Poria	Fuling	70 (89.74)	10-15
Radix Astragali Mongolici	Huangqi	63 (80.77)	15-30
Radix Angelicae Sinensis	Danggui	52 (66.67)	10-15
Cornu Cervi Elaphi	Lujiao	46 (58.97)	10-15
Carapax et Plastrum Testudinis	Guijia	46 (58.97)	10-15
Semen Cuscutae	Tusizi	44 (56.41)	15-20
Radix Rehmanniae Praeparata	Shudihuang	42 (53.85)	10-15
Fructus Psoraleae	Buguzhi	39 (50.00)	10-15

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