Decitabine Versus Hydroxyurea for Advanced Proliferative Chronic Myelomonocytic Leukemia: Results of a Randomized Phase III Trial Within the EMSCO Network. Issue 10 (1st April 2023)

• Record Type: Journal Article
• Authors: Itzykson, Raphael; Santini, Valeria; Thepot, Sylvain; Ades, Lionel; Chaffaut, Cendrine; Giagounidis, Aristoteles; Morabito, Margot; Droin, Nathalie; Lübbert, Michael; Sapena, Rosa; Nimubona, Stanislas; Goasguen, Jean; Wattel, Eric; Zini, Gina; Torregrosa Diaz, Jose Miguel; Germing, Ulrich; Pelizzari, Anna Maria; Park, Sophie; Jaekel, Nadja; Metzgeroth, Georgia; Onida, Francesco; Navarro, Robert; Patriarca, Andrea; Stamatoullas, Aspasia; Götze, Katharina; Puttrich, Martin; Mossuto, Sandra; Solary, Eric; Gloaguen, Silke; Chevret, Sylvie; Chermat, Fatiha; Platzbecker, Uwe; Fenaux, Pierre;
• Is Part Of: Journal of clinical oncology. Volume 41:Issue 10(2023)
• Page Start: 1888
• Page End: 1897
• Publication Date: 2023-04-01
• Subjects: Oncology -- Periodicals; Cancer -- Periodicals; Oncology; Medical Oncology; Cancérologie -- Périodiques; Cancer -- Périodiques; Cancérologie; Cancer; Oncology; Oncologia; Càncer; Periodicals; 616.994
• DOI: 10.1200/JCO.22.00437
• Languages: English
• ISSNs: 0732-183X

Abstract

Abstract : PURPOSE: Hydroxyurea (HY) is a reference treatment of advanced myeloproliferative neoplasms. We conducted a randomized phase III trial comparing decitabine (DAC) and HY in advanced myeloproliferative chronic myelomonocytic leukemias (CMML). PATIENTS AND METHODS: Newly diagnosed myeloproliferative CMML patients with advanced disease were randomly assigned 1:1 to intravenous DAC (20 mg/m 2 /d days 1-5) or HY (1-4 g/d) in 28-day cycles. The primary end point was event-free survival (EFS), events being death and acute myelomonocytic leukemia (AML) transformation or progression. RESULTS: One-hundred seventy patients received DAC (n = 84) or HY (n = 86). Median age was 72 and 74 years, and median WBC count 32.5 × 10 9 /L and 31.2 × 10 9 /L in the DAC and HY arms, respectively. Thirty-three percent of DAC and 31% of HY patients had CMML-2. Patients received a median of five DAC and six HY cycles. With a median follow-up of 17.5 months, median EFS was 12.1 months in the DAC arm and 10.3 months in the HY arm (hazard ratio [HR], 0.83; 95% CI, 0.59 to 1.16; P = .27). There was no significant interaction between treatment effect and blast or platelet count, anemia, CMML Prognostic Scoring System, Groupe Francophone des Myelodysplasies, or CMML Prognostic Scoring System–mol risk. Fifty-three (63%) DAC patients achieved a response compared with 30 (35%) HY patients ( P = .0004). Median duration of response was similar in both arms (DAC, 16.3 months; HY, 17.4 months; P = .90). Median overall survival was 18.4 months in the DAC arm and 21.9 months in the HY arm ( P = .67). Compared with HY, DAC significantly reduced the risk of CMML progression or transformation to acute myelomonocytic leukemia (cause-specific HR, 0.62; 95% CI, 0.41 to 0.94; P = .005) at the expense of death without progression or transformation (cause-specific HR, 1.55; 95% CI, 0.82 to 2.9; P = .04). CONCLUSION: Compared with HY, frontline treatment with DAC did not improve EFS in patients with advanced myeloproliferative CMML (ClinicalTrials.gov identifier: NCT02214407 ).