1096 - Treatment of Primary and Therapy-Related Myelodysplastic Syndrome with 5-Azacytidine – Comparative Results from a Single Centre

Abstract

ABSTRACT Introduction Therapy-related Myelodysplastic Syndrome (tMDS) is a late and rare complication of chemotherapy, especially that with alkylating agents or topoisomerase II inhibitors., They are often associated with unfavourable karyotypes, lower remission rates and shorter survival. PURPOSE: Retrospective analysis of clinical, analytical and cytogenetic features of patients diagnosed with primary (pMDS) and tMDS treated with 5-Azacytidine (AZA) between 2005 and 2011 in our Institute. Methods Data was obtained from patient notes and analysed with SPSS. Results 48 MDS patients treated with AZA were identified. 43 patients had pMDS, 57% male, median age of 67 years. The IPSS was Intermediate 2 in 42.9% and high in 40.5%; cytogenetics were normal in 33%, complex in 16.7%. A median of 7 courses (range 1-23) of AZA were administered, 52.4% as 2nd line therapy. Response assessment revealed 14.3% complete responses, 31% partial responses and 16.7% stable disease; best responses were reached after a median of 4 courses (range 2-6). Progression to secondary AML occurred in 38%; the mean survival was 25 months. Five patients had tMDS: 60% male, median age of 62 years. Previous chemotherapy included alkylating agents in 100% and topoisomerase II inhibitors in 80%. The median time to MDS development was 12 years. The IPPS risk was high in 80%; all with complex cytogenetics. A median of 6 courses of AZA were administered, 60% as 1st line therapy, with partial response in 40% (4 courses until response) and failure in 60%; 40% developed sAML and the mean survival was 12 months. DISCUSSION: Despite the small cohort size, our results were similar to those described in literature. Even with AZA treatment, tMDS patients had a worse clinical outcome, with shorter mean survival, compared to pMDS. Conclusion tMDS is a rare complication of chemotherapy with a very poor outcome. Careful review and individualization of chemotherapeutic regimens may help reduce its incidence. Disclosure All authors have declared no conflicts of interest.