Azacitidine salvage therapy for relapse of myeloid malignancies following allogeneic hematopoietic SCT.
Patients with hematopoietic malignancies relapsing after allogeneic hematopoietic SCT (allo-HSCT) have a poor prognosis. We retrospectively analyzed the patients who received azacitidine in our center in the course of treatment of their post-transplant relapse. We identified 31 patients. Relapse occurred at a median of 3.7 (1.7-37.6) months following allo-HSCT. Patients received a median number of three cycles (1-12) of azacitidine (7 days, 75 mg/m(2) daily). Thirty-nine percent of patients had either a monosomal karyotype or a complex karyotype. Eleven patients (35%) received at least one DLI. Eleven patients responded to azacitidine, with four patients achieving a CR (13%). Median time to best response was 92 (35-247) days, with a median duration of 209 (64-751) days. One-year estimated survival rate was 14%. In conclusion, azacitidine may reinduce durable remissions in very few patients with AML or myelodysplastic syndrome. The toxicity related to azacitidine was high, although it may be difficult to distinguish between treatment-related side effects, namely due to cytopenia and toxicity due to the relapse or disease progression itself. Early administration of azacitidine after transplant followed by DLI should be considered as a pre-emptive therapy for potential relapse in patients with minimal residual disease or high-risk myeloid malignancies.
1] Centre Hospitalier et Universitaire (CHU) de Nantes, Hématologie Clinique, Nantes, France [2] INSERM CRCNA, UMR 892, Nantes, France.
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Tessoulin
1] Centre Hospitalier et Universitaire (CHU) de Nantes, Hématologie Clinique, Nantes, France [2] INSERM CRCNA, UMR 892, Nantes, France [3] Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France.
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Delaunay
1] Centre Hospitalier et Universitaire (CHU) de Nantes, Hématologie Clinique, Nantes, France [2] INSERM CRCNA, UMR 892, Nantes, France [3] Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France.
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Chevallier
Centre Hospitalier et Universitaire (CHU) de Nantes, Hématologie Clinique, Nantes, France.
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Loirat
Centre Hospitalier et Universitaire (CHU) de Nantes, Hématologie Clinique, Nantes, France.
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Ayari
Centre Hospitalier et Universitaire (CHU) de Nantes, Hématologie Clinique, Nantes, France.
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Peterlin
1] Centre Hospitalier et Universitaire (CHU) de Nantes, Hématologie Clinique, Nantes, France [2] INSERM CRCNA, UMR 892, Nantes, France [3] Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France [4] Université de Nantes, Nantes, France.
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Le Gouill
1] Centre Hospitalier et Universitaire (CHU) de Nantes, Hématologie Clinique, Nantes, France [2] Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France.
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Gastinne
1] Centre Hospitalier et Universitaire (CHU) de Nantes, Hématologie Clinique, Nantes, France [2] INSERM CRCNA, UMR 892, Nantes, France [3] Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France [4] Université de Nantes, Nantes, France.
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Moreau
1] Centre Hospitalier et Universitaire (CHU) de Nantes, Hématologie Clinique, Nantes, France [2] INSERM CRCNA, UMR 892, Nantes, France [3] Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France [4] Université de Nantes, Nantes, France.
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Mohty
1] Centre Hospitalier et Universitaire (CHU) de Nantes, Hématologie Clinique, Nantes, France [2] INSERM CRCNA, UMR 892, Nantes, France [3] Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France.
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Guillaume
D000293:Adolescent; D000328:Adult; D000368:Aged; D001374:Azacitidine / Q000627:therapeutic use*; D005260:Female; D019337:Hematologic Neoplasms / Q000188:drug therapy* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D014184:Transplantation, Homologous; D055815:Young Adult
D001374:Azacitidine