Maintenance azacitidine after myeloablative allogeneic hematopoietic cell transplantation for myeloid malignancies.
Allogeneic hematopoietic cell transplantation (HCT) is a curative option for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS), but carries a high risk of relapse. This retrospective review evaluates the effectiveness of maintenance azacitidine in high-risk AML and MDS patients to reduce the probability of relapse. Twenty-five patients who received maintenance azacitidine were matched to historical controls in a two-to-one ratio based on diagnosis, donor type, conditioning regimen intensity, and age. Over 90% of patients received myeloablative conditioning. There was no difference in time to hematologic relapse, overall survival, or non-relapse mortality. Maintenance therapy was stopped early in 72% of patients due to graft-versus-host-disease, relapse, infection, and intolerance (13 of 25 patients received less than 4 cycles). There was a trend towards higher toxicity in the azacitidine group. The use of prophylactic azacitidine following myeloablative allogeneic HCT outside a clinical trial cannot be recommended at this time.
Published In/Presented At
Maples, K. T., Sabo, R. T., McCarty, J. M., Toor, A. A., & Hawks, K. G. (2018). Maintenance azacitidine after myeloablative allogeneic hematopoietic cell transplantation for myeloid malignancies. Leukemia & lymphoma, 59(12), 2836–2841. https://doi.org/10.1080/10428194.2018.1443334
Medicine and Health Sciences
Department of Medicine, Hematology-Medical Oncology Division