Journal
BONE MARROW TRANSPLANTATION
Volume 49, Issue 4, Pages 567-571Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/bmt.2013.233
Keywords
azacitidine; allo-HSCT; relapse
Categories
Funding
- Association pour la Recherche sur le Cancer [3175]
- Fondation de France
- Fondation contre la Leucemie
- Agence de Biomedecine
- Association Cent pour Sang la Vie
- Association Laurette Fuguain
- IRGHET
- Ligue contre le Cancer
- Association for Training, Education and Research in Hematology, Immunology and Transplantation (ATERHIT)
- National Cancer Institute
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Patients with hematopoietic malignancies relapsing after allogeneic hematopoietic SCT (allo-HSCT) have a poor prognosis. We retrospectively analyzed the patients who received azacitidine in our center in the course of treatment of their post-transplant relapse. We identified 31 patients. Relapse occurred at a median of 3.7 (1.7-37.6) months following allo-HSCT. Patients received a median number of three cycles (1-12) of azacitidine (7 days, 75 mg/m(2) daily). Thirty-nine percent of patients had either a monosomal karyotype or a complex karyotype. Eleven patients (35%) received at least one DLI. Eleven patients responded to azacitidine, with four patients achieving a CR (13%). Median time to best response was 92 (35-247) days, with a median duration of 209 (64-751) days. One-year estimated survival rate was 14%. In conclusion, azacitidine may reinduce durable remissions in very few patients with AML or myelodysplastic syndrome. The toxicity related to azacitidine was high, although it may be difficult to distinguish between treatment-related side effects, namely due to cytopenia and toxicity due to the relapse or disease progression itself. Early administration of azacitidine after transplant followed by DLI should be considered as a pre-emptive therapy for potential relapse in patients with minimal residual disease or high-risk myeloid malignancies.
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