title: Outcome of therapy-related myeloid neoplasms treated with azacitidine.
abstract: BACKGROUND
  Therapy-related myeloid neoplasms (t-MN), including myelodysplastic syndromes and acute myeloid leukemia (t-MDS and t-AML) are associated to clinical and biologic unfavorable prognostic features, including high levels of DNA methylation.
  
  
  METHODS
  We retrospectively evaluated 50 t-MN patients (34 MDS and 16 AML) selected among all patients receiving azacitidine (AZA) at 10 Italian Hematology Centers. Patients had developed a t-MN at a median of 6.5 years (range 1.7- 29) after treatment of the primary tumor (hematological neoplasm, 27 patients; solid tumor, 23 patients).
  
  
  RESULTS
  The overall response rate was 42% (complete remission: 10 patients, partial remission: 2 and hematological improvement: 8 patients) and was obtained after a median of 3 cycles (range 1-6). Median overall survival (OS) was 21 months (range 1-53.6+) from AZA start. OS was significantly better in patients with less than 20% blasts, in normal karyotype t-AML and when AZA was used as front-line treatment. This was confirmed by the multivariate analysis.
  
  
  CONCLUSIONS
  This study reports efficacy of AZA in the largest series of therapy-related MN patients treated with 5-AZA. Our data show that blasts and karyotype maintain their important prognostic role in t-MN also in the azacitidine era.
authors.affiliation: Istituto di Ematologia, Università Cattolica del Sacro Cuore, 00168, Roma, Italy.
authors.forename: Luana
authors.initials: L
authors.lastname: Fianchi
authors.forename: Marianna
authors.initials: M
authors.lastname: Criscuolo
authors.forename: Monia
authors.initials: M
authors.lastname: Lunghi
authors.forename: Gianluca
authors.initials: G
authors.lastname: Gaidano
authors.forename: Massimo
authors.initials: M
authors.lastname: Breccia
authors.forename: Alessandro
authors.initials: A
authors.lastname: Levis
authors.forename: Carlo
authors.initials: C
authors.lastname: Finelli
authors.forename: Valeria
authors.initials: V
authors.lastname: Santini
authors.forename: Pellegrino
authors.initials: P
authors.lastname: Musto
authors.forename: Esther N
authors.initials: EN
authors.lastname: Oliva
authors.forename: Pietro
authors.initials: P
authors.lastname: Leoni
authors.forename: Antonietta
authors.initials: A
authors.lastname: Aloe Spiriti
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Alò
authors.forename: Stefan
authors.initials: S
authors.lastname: Hohaus
authors.forename: Livio
authors.initials: L
authors.lastname: Pagano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Leone
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Voso
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001374:Azacitidine / Q000627:therapeutic use*; D019175:DNA Methylation / Q000187:drug effects*; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000401:mortality; D016609:Neoplasms, Second Primary / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000964:Antimetabolites, Antineoplastic; D001374:Azacitidine