Low-dose azacitidine after allogeneic stem cell transplantation for acute leukemia
Elias Jabbour, Sergio Giralt, Hagop Kantarjian, Guillermo Garcia-Manero, Madan Jagasia, Partow Kebriaei, Leandro de Padua, Elizabeth J Shpall, Richard Champlin, Marcos de Lima, Elias Jabbour, Sergio Giralt, Hagop Kantarjian, Guillermo Garcia-Manero, Madan Jagasia, Partow Kebriaei, Leandro de Padua, Elizabeth J Shpall, Richard Champlin, Marcos de Lima
Abstract
Background: : The authors hypothesized that low doses of the hypomethylating agent 5-azacitidine may maximize the graft-versus-leukemia effect and may be tolerated well after allogeneic transplantation (HSCT).
Methods: : The drug was given to 17 patients with acute leukemia as salvage for disease recurrence after HSCT (n = 9 patients) or as maintenance therapy (n = 8 patients). 5-Azacitidine was given subcutaneously daily for 5 days and was repeated every 4 weeks at doses of 16 mg/m(2) (n = 4 patients), 24 mg/m(2) (n = 9 patients), and 40 mg/m(2) (n = 4 patients). A median of 8 cycles was delivered. The median follow-up was 16 months and 11 months after HSCT and 5-azacitidine treatment, respectively.
Results: : Five of 9 patients with recurrent disease responded. Four of 13 responding patients developed disease recurrence while they were receiving 5-azacitidine after a median of 10 months. The actuarial 1-year event-free and overall survival rates were 55% and 90%, respectively. There were no extramedullary toxicities, and no graft-versus-host disease exacerbation was observed.
Conclusions: : Low-dose 5-azacitidine may induce durable remissions for patients who develop disease recurrence after HSCT. Further follow-up and a larger group of patients will be necessary to confirm these observations. Cancer 2009. (c) 2009 American Cancer Society.
Conflict of interest statement
Conflict of Interest Disclosures
The authors made no disclosures.
Source: PubMed