title: Minimizing risk of hypomethylating agent failure in patients with higher-risk MDS and practical management recommendations.
abstract: In Europe, azacitidine is the only hypomethylating agent approved for the treatment of patients with int-2-/high-risk myelodysplastic syndromes, offering significantly improved survival compared with conventional care. However, not all patients treated with azacitidine respond to treatment, and the vast majority of responders subsequently relapse. Currently, no standard care regimens have been established for patients after failure of azacitidine. Here, we discuss treatment options after loss of response or progression on azacitidine. In addition, we briefly consider optimization of first-line treatment along with potential biomarkers for identifying and monitoring response during treatment with azacitidine.
authors.affiliation: University of Florence, Florence, Italy. Electronic address: valeria.santini@unifi.it.
authors.forename: Valeria
authors.initials: V
authors.lastname: Santini
authors.affiliation: Département d'Hématologie, Centre de recherche en Cancerologie de Marseille, Institut Paoli Calmettes, Marseille, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Prebet
authors.affiliation: Hopital Avicenne, Assistance Publique, Hôpitaux de Paris and Paris 13 University, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Fenaux
authors.affiliation: Klinik für Hämatologie, Onkologie u klin Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Gattermann
authors.affiliation: Department of Haematology and Coagulation Disorders, Skåne University Hospital, Lund, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Nilsson
authors.affiliation: 3rd Medical Department, Hanusch Hospital, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Pfeilstöcker
authors.affiliation: Department of Haematology, University of Oxford and Oxford University Hospitals, UK.
authors.forename: Paresh
authors.initials: P
authors.lastname: Vyas
authors.affiliation: H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
authors.forename: Alan F
authors.initials: AF
authors.lastname: List
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001374:Azacitidine / Q000627:therapeutic use*; D015415:Biomarkers; D018572:Disease-Free Survival; D005060:Europe / Q000453:epidemiology; D006801:Humans; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000401:mortality; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000964:Antimetabolites, Antineoplastic; D015415:Biomarkers; D001374:Azacitidine
keywords: Azacitidine; Consensus; Hypomethylating agents; MDS; Refractory; Relapse; Salvage therapy