Combination of azacitidine and ESA in myelodysplastic patients: The need for prospective studies

Abstract

We read with great interest the paper by Itzkynson et al. [1] hat reported the results of the combination of erythropoietin and zacitidine in myelodysplastic syndrome (MDS) patients. Overall, 2 out of 282 patients were treated concomitantly with azacitiine and erythropoietic stimulating agents (ESA) for a relatively hort period of time (median duration 5.8 months). The authors eported an overall response rate of 53% in patients treated with the ombination compared to 43% in patients treated with azacitidine lone, without statistically significant difference. No differences ere reported in terms of complete response (CR) and marrow esponse (mCR) between the two groups of subjects, whereas the ate of hematologic improvement-erythroid (HI-E) was superior in he combination group (44%) compared to azacitidine alone group 27%), with an increased rate of patients becoming transfusion ndependent in the former group. Again no difference in terms of rogression rate was observed, whereas ESA-treated patients had longer survival (OS), with a median of 19.6 months compared to 1.9 months for patients who did not receive ESA. With the aim to valuate the possible effect of the above described combination, 60 DS patients treated with azacitidine in our institute, 8 of whom eceived the drug in association with ESA, were retrospectively anaysed. There were 44 males and 16 females, median age 69 years range 44–83). According to WHO criteria [2], 35 patients were