title: Impact of azacitidine before allogeneic stem-cell transplantation for myelodysplastic syndromes: a study by the Société Française de Greffe de Moelle et de Thérapie-Cellulaire and the Groupe-Francophone des Myélodysplasies.
abstract: OBJECTIVE
  To investigate the impact of prior-to-transplantation azacitidine (AZA) on patient outcome after allogeneic stem-cell transplantation (alloSCT) for myelodysplastic syndrome (MDS).
  
  
  METHODS
  Of the 265 consecutive patients who underwent alloSCT for MDS between October 2005 and December 2009, 163 had received cytoreductive treatment prior to transplantation, including induction chemotherapy (ICT) alone (ICT group; n = 98), AZA alone (AZA group; n = 48), or AZA preceded or followed by ICT (AZA-ICT group; n = 17). At diagnosis, 126 patients (77%) had an excess of marrow blasts, and 95 patients (58%) had intermediate-2 or high-risk MDS according to the International Prognostic Scoring System (IPSS). Progression to more advanced disease before alloSCT was recorded in 67 patients. Donors were sibling (n = 75) or HLA-matched unrelated (10/10; n = 88). They received blood (n = 142) or marrow (n = 21) grafts following either myeloablative (n = 33) or reduced intensity (n = 130) conditioning.
  
  
  RESULTS
  With a median follow-up of 38.7 months, 3-year outcomes in the AZA, ICT, and AZA-ICT groups were 55%, 48%, and 32% (P = .07) for overall survival (OS); 42%, 44%, and 29% (P = .14) for event-free survival (EFS); 40%, 37%, and 36% (P = .86) for relapse; and 19%, 20%, and 35% (P = .24) for nonrelapse mortality (NRM), respectively. Multivariate analysis confirmed the absence of statistical differences between the AZA and the ICT groups in terms of OS, EFS, relapse, and NRM.
  
  
  CONCLUSIONS
  With the goal of downstaging underlying disease before alloSCT, AZA alone led to outcomes similar to those for standard ICT.
authors.affiliation: Centre Hospitalier Universitaire Sud, Amiens, France.
authors.forename: Gandhi
authors.initials: G
authors.lastname: Damaj
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.forename: Marie
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authors.lastname: Robin
authors.forename: Yves
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authors.lastname: Beguin
authors.forename: Mauricette
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authors.lastname: Michallet
authors.forename: Mohamad
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authors.lastname: Mohty
authors.forename: Stephane
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authors.lastname: Vigouroux
authors.forename: Pierre
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authors.lastname: Bories
authors.forename: Alice
authors.initials: A
authors.lastname: Garnier
authors.forename: Jean
authors.initials: J
authors.lastname: El Cheikh
authors.forename: Claude-Eric
authors.initials: CE
authors.lastname: Bulabois
authors.forename: Anne
authors.initials: A
authors.lastname: Huynh
authors.forename: Jacques-Olivier
authors.initials: JO
authors.lastname: Bay
authors.forename: Faeyzeh
authors.initials: F
authors.lastname: Legrand
authors.forename: Eric
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authors.lastname: Deconinck
authors.forename: Nathalie
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authors.lastname: Fegueux
authors.forename: Laurence
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authors.lastname: Clement
authors.forename: Charles
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authors.lastname: Dauriac
authors.forename: Natacha
authors.initials: N
authors.lastname: Maillard
authors.forename: Jérôme
authors.initials: J
authors.lastname: Cornillon
authors.forename: Lionel
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authors.lastname: Ades
authors.forename: Gaelle
authors.initials: G
authors.lastname: Guillerm
authors.forename: Aline
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authors.lastname: Schmidt-Tanguy
authors.forename: Zora
authors.initials: Z
authors.lastname: Marjanovic
authors.forename: Sophie
authors.initials: S
authors.lastname: Park
authors.forename: Marie-Thérèse
authors.initials: MT
authors.lastname: Rubio
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Marolleau
authors.forename: Federico
authors.initials: F
authors.lastname: Garnier
authors.forename: Ierre
authors.initials: I
authors.lastname: Fenaux
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yakoub-Agha
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects / Q000627:therapeutic use*; D001374:Azacitidine / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D014184:Transplantation, Homologous / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D001374:Azacitidine