Bridging-to-transplant with Azacitidine for Myelodysplastic Syndrome and Acute Myeloid Leukemia, Reduces the Incidence of Acute Graft-versus-host Disease.

Koichi Murakami,Akihiro Yokoyama,Takahiro Yano,Saigen Boku,Toshiya Kagoo,Hironori Ueno,Takashi Okabe

doi:10.4081/hr.2017.7114

Koichi Murakami, Akihiro Yokoyama + Show 5 more

Open Access

https://doi.org/10.4081/hr.2017.7114

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Abstract

Allogeneic stem cell transplantation (allo-SCT) is the only curative option for myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). Azacitidine (AZA) has a good toxicity profile compared with intensive chemotherapy and can be considered a pre-transplant regimen in elderly patients and in patients with comorbidities. To investigate the impact of pre-transplant AZA on patient outcome after allo-SCT, we conducted a retrospective analysis of AZA pre-treatment followed by allo-SCT in patients with high-risk MDS and AML. Twenty patients who were divided into two groups according to AZA treatment given prior to allo-SCT (AZA vs non-AZA group, 10 each). Overall survival, event-free survival and incidence of chronic graft-versus-host disease (GVHD) were not significantly different between the two groups. The overall incidence of grade II to IV acute GVHD in the AZA group was significantly lower than that in the non-AZA group (P=0.004). Bridging to transplant with AZA should be considered as an immunomodulator and effective treatment strategy for patients with MDS and AML.

Highlights

No graft drome (MDS) and acute myeloid leukemia and total body irradiation (TBI) (n=3), failure was seen in either group
Our study has showed a similar tendency on Overall survival (OS) and event-free survival (EFS)
The incidence rate of acute and chronic graft-versus-host disease (GVHD) were not reported in study by Damaj et al Oshikawa et al.[10] retrospectively reviewed clinical outcome of 15 myelodysplastic syndrome (MDS) patients who were treated with AZA before allo-SCT (AZA group) compared with group were older with higher IPSS scores compared to patients in the best supportive care (BSC) group, no significant differences were found between the two groups in OS; 79.0 and 78.6%, disease-free survival (DFS); 71.2 and 59.2%, cumulative incidence of relapse; 15.4 and 11.3% or non-relapse mortality; 21.0 and 13.5%, at 1 year

Summary

Materials and Methods

All twenty patients were divided into two groups according to AZA treatment given prior to allo-SCT (AZA vs non-AZA group, 10 each). The AZA group consisted of 6 men and 4 women, while the non-AZA group had 7 men and 3 women. The median age at transplantation of the AZA group and the nonAZA group was 53 years (32-66) and 52.5 script. Conflict of interest: the authors declare no potential conflict of interest. 2017 Licensee PAGEPress, Italy Hematology Reports 2017; 9:7114 doi:10.4081/hr.2017.7114 related donor, and tacrolimus with sMTX for alternative donor. All statistical analyses were performed with EZR.[9]

Results

HLA compatibility

Considering the lower rate of acute