Objective:

2

To explore the effect of Qinghuang Powder (QHP

青黄散) combined with Bupi Yishen Decoction (BPYS

补脾益肾方) on myelodysplastic syndromes (MDS) patients with refractory cytopenia with multilineage dysplasia (RCMD) and determine the change of DNA methylation in MDS-RCMD patients after the treatment of Chinese medicine formula.

Methods:

2

All 308 MDS-RCMD patients were treated with QHP combined with BPYS for 2 months at least

absolute neutrophil count (ANC)

hemoglobin (Hb)

platelets (PLT)

primitive bone marrow cells and chromosome karyotype were chosen as the main evaluation indexes to analyze the treatment effect according to criteria from the MDS International Working Group. Then 43 bone marrow samples from 15 MDS-RCMD patients and 28 healthy donors were obtained for the examination of DNA methylation. Gene Ontology (GO) and Pathway analysis were applied to analyze the methylation data.

Results:

2

The overall MDS response rate to QHP was 61.68% (190/360) including hematologic improvement-neutrophil (HI-N) or hematologic improvement-erythroid (HI-E) or hematologic improvement-platelet (HI-P). Patients with anemia had a better response rate than patients with neutropenia or thrombocypenia (55.88% vs 31.54% or 55.88% vs. 36.9%). The DNA methylation microarray analysis disclosed that 4

257 hypermethylated genes were demethylated upon the treatment with QHP and BPYS. GO analysis and Pathway analysis showed that these demethylated genes were involved in a lot of tumor-related pathways and functions.

Conclusions:

2

QHP combined with BPYS could effectively treat MDS-RCMD patients through hematologic improvement (HI-N

HI-P or HI-E) and PLT and RBC transfusion independence due to the demethylation

thereby providing another choice for the treatment of patients with MDS-RCMD.