title: Efficacy of Azacitidine in De Novo and Relapsed Acute Myeloid Leukemia: A Retrospective Comparative Study.
abstract: BACKGROUND
  Azacitidine is a therapeutic alternative to low-dose cytarabine in patients with acute myeloid leukemia (AML) who are unfit for intensive chemotherapy.
  
  
  METHODS
  We retrospectively analyzed all AML patients treated with azacitidine at the University Hospital Zurich and the Kantonsspital Munsterlingen between January 2005 and December 2011. The primary end point was overall survival (OS).
  
  
  RESULTS
  Thirty-eight patients were included in the analysis. Twenty-one (55%) patients had newly diagnosed AML, 14 (37%) had relapsed AML, and 3 (8%) underwent bridging therapy before allogeneic stem-cell transplantation. Age at diagnosis was 72 years in the newly diagnosed cohort and 58 years in the relapsed cohort, 19 (50%) patients were female, 20 (53%) patients were transfusion dependent, and bone marrow blast count was 43% (interquartile range, 26-80). Most patients (58%) had poor or very poor risk AML. Patients received a median (range) of 7 (3-13) therapy cycles. The median (range) OS in the newly diagnosed and previously treated patient groups were 308 (175-580) days and 346 (293-628) days, respectively (P = .94). Median OS in the 3 patients treated before allogeneic stem-cell transplantation has not been reached. Sixty-day mortality was 7.9%, with no difference between the 2 groups. Ongoing or increasing transfusion dependency was associated with adverse outcome (hazard ratio, 3.09; 95% confidence interval, 1.29-7.37, P = .011).
  
  
  CONCLUSIONS
  Treatment with azacitidine led to a median OS of 10 months in both a previously untreated and a previously treated frail AML patient cohort. A positive effect in transfusion dependency was observed in 29% of these patients and was associated with better survival.
authors.affiliation: Division of Hematology, University Hospital and University of Zurich, Zurich, Switzerland.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Gemuenden
authors.affiliation: Department of Internal Medicine, Kantonsspital Munsterlingen, Munsterlingen, Switzerland.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Benz
authors.affiliation: Institute of Primary Care, University Hospital and University of Zurich, Zurich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Senn
authors.affiliation: Division of Hematology, University Hospital and University of Zurich, Zurich, Switzerland.
authors.forename: Jeroen S
authors.initials: JS
authors.lastname: Goede
authors.affiliation: Division of Hematology, University Hospital and University of Zurich, Zurich, Switzerland.
authors.forename: Markus G
authors.initials: MG
authors.lastname: Manz
authors.affiliation: Division of Hematology, University Hospital and University of Zurich, Zurich, Switzerland. Electronic address: bernhard.gerber@usz.ch.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Gerber
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001374:Azacitidine / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D001374:Azacitidine
keywords: Acute myeloid leukemia; Azacitidine; Hospitalization; Overall survival; Transfusion