Azacitidine as salvage therapy for relapsed acute myeloid leukemia/myelodysplastic syndrome after allogeneic hematopoietic stem cell transplantation. Issue 3 (24th April 2019)

• Record Type: Journal Article
• Authors: Ozawa, Takayuki; Fuji, Shigeo; Kawashima, Ichiro; Sueki, Yuki; Hagihara, Masao; Handa, Naoko; Ito, Reiko; Yamashita, Tomoko; Kikuchi, Yuji; Ohwada, Akira; Matsuura, Yasuhiro; Yoshifuji, Kota; Tanaka, Takashi; Inamoto, Yoshihiro; Kurosawa, Saiko; Kim, Sung‐Won; Fukuda, Takahiro
• Is Part Of: Advances in cell and gene therapy. Volume 2:Issue 3(2019)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-04-24
• Subjects: acute myeloid leukemia -- allogeneic stem cell transplantation -- azacitidine -- myelodysplastic syndrome -- salvage therapy; Cellular therapy -- Periodicals; Gene therapy -- Periodicals; Immunotherapy -- Periodicals; Cancer -- Treatment -- Periodicals; Bone marrow -- Diseases -- Treatment -- Periodicals; Blood -- Diseases -- Treatment -- Periodicals; 615.5
• DOI: 10.1002/acg2.58
• Languages: English
• ISSNs: 2573-8461

Abstract

Abstract: Objective: There are no established salvage therapies for relapsed myeloid malignancies after allogeneic hematopoietic stem cell transplantation (allo‐HSCT). Azacitidine (AZA) has been reported as a promising treatment in such cases. Methods: We conducted a retrospective analysis of patients at our institution who received AZA for relapse after allo‐HSCT between 2014 and 2015. Results: Twenty‐two patients received AZA as salvage therapy; 19 had acute myeloid leukemia and 3 had myelodysplastic syndrome. The median number of AZA cycles was 2 (range, 1‐12). Seventy‐seven percent of patients received AZA at a dose of 75 mg/m 2 for either 5 or 7 days. The median interval between each AZA administration was 32 days (20‐63 days). Donor lymphocyte infusion (DLI) was administered in 5 patients. The median follow‐up period after AZA therapy was 360 days (range, 63‐805). The overall response rate was 15% in patients with non‐hematological CR (Non‐HCR) or hematological relapse (H‐Rel) and 56% in patients with molecular relapse (M‐Rel). The 1‐year overall survival (OS) rates in patients with Non‐HCR/H‐Rel and M‐Rel were 37.3% and 74.1%, respectively ( P = 0.30). Patients who received DLI had favorable OS, and those with early H‐Rel had poor OS. Grade 3‐4 infection occurred in 12 patients. Discussion: Our study suggests that AZA ± DLI is a tolerable and promising treatment in M‐Rel patients. The efficacy of AZA in H‐Rel patients is limited.