title: Azacitidine Use After Allogeneic Stem Cell Transplantation-Results From the Polish Adult Leukemia Group.
abstract: BACKGROUND
  Relapse of primary hematologic disease constitutes an important reason for failure of allogeneic hematopoietic stem cell transplantation (alloHSCT). There are very few treatment modalities for this indications. Therefore, there is a need for novel effective therapies and even more for the prevention of relapse. There are scarce data that azacitidine can be used for these purposes.
  
  
  METHODS
  At the Polish Adult Leukemia Group, we retrospectively analyzed the results of azacitidine treatment after alloHSCT. Relapsing patients, patients with minimal residual disease/mixed chimerism, and patients in complete remission with high risk of relapse were analyzed separately. There were 17 patients, 6 with myelodysplastic syndrome, 11 with acute myeloid leukemia, 8 male, and overall median age of 56 years (range, 15-78); 7 patients received donor lymphocyte infusion (DLI).
  
  
  RESULTS
  Patients treated because of relapse received a median of 3 (range, 1-6) cycles of azacitidine, patients receiving preemptive treatment received a median of 4 cycles (range, 2-6), and those on maintenance received a median of 5 cycles (range, 3-5). Toxicity was considerable, especially in relapse-neutropenia (67%), anemia (67%), thrombocytopenia (100%), serious infections (78%)-and preemptive settings. Median overall survival of patients treated for relapse reached 6.8 months (95% confidence interval [CI], 0.7-∞), with better survival observed in patients with temporary disease control (7.7 vs 4.7 mo) and without previous exposure to azacitidine (7.7 vs 3.4 mo). One-year overall survival reached 75% (95% CI, 13%-96%) for preemptive and 50% (95% CI, 0%-91%) for maintenance treatment. DLI did not aggravate graft-versus-host disease.
  
  
  CONCLUSIONS
  Effectiveness of azacitidine in relapsing patients is disappointing. Azacitidine seems to be promising in preemptive and maintenance settings. Toxicity is considerable. Further research is needed.
authors: Department of Hematology, Oncology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland. Electronic address: johna.dr@poczta.fm.
authors: J
authors: J
authors: Drozd-Sokołowska
authors: Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland.
authors: L
authors: L
authors: Gil
authors: Department of Hematology, Oncology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors: A
authors: A
authors: Waszczuk-Gajda
authors: Department of Hematology, Oncology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors: K
authors: K
authors: Mądry
authors: Department of Hematology and Transplantology, Medical University of Gdansk, Gdansk, Poland.
authors: A
authors: A
authors: Piekarska
authors: Department of Hematology and Transplantology, Medical University of Gdansk, Gdansk, Poland.
authors: M
authors: M
authors: Dutka
authors: Department of Hematology, Oncology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors: G W
authors: GW
authors: Basak
authors: Department of Hematology, Oncology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors: E
authors: E
authors: Karakulska-Prystupiuk
authors: Department of Hematology, Oncology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors: J
authors: J
authors: Dwilewicz-Trojaczek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001374:Azacitidine / Q000627:therapeutic use*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality; D011044:Poland; D012189:Retrospective Studies; D014184:Transplantation, Homologous / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000964:Antimetabolites, Antineoplastic; D001374:Azacitidine