title: Factors Determining Responses to Azacitidine in Patients with Myelodysplastic Syndromes and Acute Myeloid Leukemia with Early Post-Transplantation Relapse: A Prospective Trial.
abstract: Retrospective analyses suggest a benefit of therapy with hypomethylating agents in patients with myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) who relapse after allogeneic hematopoietic cell transplantation (HCT). We conducted a prospective trial in 39 patients with MDS or AML who relapsed within 100 days of HCT. Relapse was documented by morphology, flow cytometry, or cytogenetics. Treatment consisted of 5-azacitidine, 75 mg/m2/day for 7 days, administered every 28 days. Patients were followed by sequential marrow examinations, and responses were assessed at 6 months. There were 3 complete remissions and 9 partial remissions (30%); an additional 3 patients had stable disease by International Working Group criteria. In multivariate analysis, only the type of induction chemotherapy given before HCT was significantly associated with post-HCT response to 5-azacitidine and overall survival (P = .004). These data support the use of hypomethylating therapy for post-HCT relapse in patients with MDS and AML and suggest that pre-HCT therapy may affect the likelihood of response to this salvage approach.
authors: Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington.
authors: Janghee
authors: J
authors: Woo
authors: Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington.
authors: H Joachim
authors: HJ
authors: Deeg
authors: Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington.
authors: Barry
authors: B
authors: Storer
authors: Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington.
authors: Cecilia
authors: C
authors: Yeung
authors: Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington.
authors: Min
authors: M
authors: Fang
authors: Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington.
authors: Marco
authors: M
authors: Mielcarek
authors: Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington. Electronic address: bscott@fredhutch.org.
authors: Bart L
authors: BL
authors: Scott
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D001374:Azacitidine / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality* / Q000592:standards; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods*; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012074:Remission Induction / Q000379:methods*; D015996:Survival Rate
chemical_list: D000964:Antimetabolites, Antineoplastic; D001374:Azacitidine
keywords: Azacitidine; Clonal evolution; Early post-transplantation relapse; Myelodysplastic syndromes