title: Hypomethylating Agents for Relapse after Allogeneic Hematopoietic Cell Transplantation in Myeloid Malignancies: A Case Series and Review of the Literature.
abstract: Relapse is a leading cause of mortality after allogeneic hematopoietic cell transplantation (HCT). Hypomethylating agents (HMAs) have immunomodulatory properties, including augmenting tumor antigen presentation that may enhance the graft-versus-leukemia effect. Moreover, inhibitory effects on T-cell activation and cytokine production may lead to a lower incidence of graft-versus-host disease (GVHD). Our aim was to describe outcomes in patients treated with HMAs for relapse after HCT.
  
  
  
  Subjects were retrospectively identified as patients with relapse or loss of donor chimerism after HCT for myeloid malignancies treated with HMAs at the University of Pittsburgh.
  
  
  
  Thirteen patients were identified, with a median age of 57 years and a median time to relapse of 98 days. Nine of 12 (75%) evaluable patients had a complete remission (CR). Grade I-IV acute GVHD involving the liver occurred in 6 patients. Cases of acute liver GVHD were diagnosed clinically based on the elevation of liver function tests. The median survival was 14.3 months from the time of relapse.
  
  
  
  HMAs for relapse after HCT can be effective in inducing a CR. This may be due to epigenetic changes and immunomodulatory effects that enhance the graft-versus-leukemia effect. There may be a risk of GVHD, and further exploration into pathophysiology and predisposing factors are warranted.
authors.affiliation: Division of Hematology/Oncology, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, Pa., USA.
authors.forename: Annie
authors.initials: A
authors.lastname: Im
authors.forename: Anastasios
authors.initials: A
authors.lastname: Raptis
authors.forename: Jing-Zhou
authors.initials: JZ
authors.lastname: Hou
authors.forename: Cheryl
authors.initials: C
authors.lastname: Tompkins
authors.forename: Melissa
authors.initials: M
authors.lastname: Winfield
authors.forename: Mary
authors.initials: M
authors.lastname: Guay
authors.forename: Michael
authors.initials: M
authors.lastname: Boyiadzis
authors.forename: Mounzer
authors.initials: M
authors.lastname: Agha
mesh_terms: D006086:Graft vs Host Disease; D019337:Hematologic Neoplasms; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous