Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Conditioning Regimens

5-Azacitidine for myelodysplasia before allogeneic hematopoietic cell transplantation

Abstract

Relapse remains a leading cause for treatment failure after hematopoietic cell transplantation (HCT) in patients with intermediate- or high-risk myelodysplastic syndrome (MDS). To discern the impact of 5-azacitine treatment pretransplant on the risk for relapse after HCT, we analyzed the post transplant outcomes of all 54 consecutive patients with MDS or chronic myelomonocytic leukemia who received HCT from HLA-compatible donors according to pretransplant 5-azacitidine exposure. Thirty patients received a median of four (1–7) cycles of 5-azacitidine, and 24 patients did not receive 5-azacitidine before HCT. The 1-year estimates of overall survival, relapse-free survival and cumulative incidence of relapse were 47, 41 and 20%, for 5-azacitidine patients and 60, 51 and 32%, respectively, for non-5-azacytidine patients. These observations suggest that outcomes are similar in both groups with a trend toward decreased early relapse in patients receiving 5-azacitidine. 5-Azacitidine may be of value in stabilizing the disease, thereby allowing time for patients to reach transplant and does not appear to affect transplant outcomes.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Greenberg P, Cox C, LeBeau MM, Fenaux P, Morel P, Sanz G et al. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood 1997; 89: 2079–2088.

    CAS  PubMed  Google Scholar 

  2. Cutler CS, Lee SJ, Greenberg P, Deeg HJ, Perez WS, Anasetti C et al. A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome. Blood 2004; 104: 579–585.

    Article  CAS  PubMed  Google Scholar 

  3. Silverman LR, Demakos EP, Peterson BL, Kornblith AB, Holland JC, Odchimar-Reissig R et al. Randomized controlled trial of azacitidine in patients with the myelodysplastic syndrome: a study of the cancer and leukemia group B. J Clin Oncol 2002; 20: 2429–2440.

    Article  CAS  PubMed  Google Scholar 

  4. Fenaux P, Mufti GJ, Hellstrom-Lindberg E, Santini V, Finelli C, Giagounidis A et al. Efficacy of azacytidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: a randomized, open-label, phase III study. www.thelancet.com/oncology. Published online February 18, 2009.

  5. Field T, Alsina M, Ayala E, Fernandez H, Janssen W, Karfan-Dabaja MA et al. Allogeneic hematopoietic cell transplantation (HCT) for myelodysplastic syndrome (MDS) after pretransplant 5-azacitidine (Vidaza). Blood 2007; 110: 339b (abstract 5035).

    Article  Google Scholar 

  6. de Lima M, Couriel D, Thall PF, Wang X, Madden T, Jones R et al. Once-daily intravenous busulfan and fludarabine: Clinical and pharmacokinetic results of a myeloablative, reduced-toxicity conditioning regimen for allogeneic stem cell transplantation in AML and MDS. Blood 2004; 104: 857–864.

    Article  CAS  PubMed  Google Scholar 

  7. Bacigalupo A, Lamparelli T, Bruzzi P, Guidi S, Alessandrino PE, di Bartolomeo P et al. Antithymocyte globulin for graft-versus-host disease prophylaxis in transplants from unrelated donors: 2 randomized studies from Gruppo Italiano Trapianti Midollo Osseo (GITMO). Blood 2001; 98: 2942–2947.

    Article  CAS  PubMed  Google Scholar 

  8. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J et al. 1994 Consensus Conference on Acute GVHD grading. Bone Marrow Transplant 1995; 15: 825–828.

    CAS  PubMed  Google Scholar 

  9. Marubini E, Valsecchi MG . Analysing Survival Data from Clinical Trials and Observational Studies. John Wiley & Sons: New York, 1995, pp 331–362.

    Google Scholar 

  10. Gray R . A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 1988; 16: 1141–1154.

    Article  Google Scholar 

  11. Fine JP, Gray RJ . A proportional hazards model for the sub-distribution of a competing risk. J Am Stat Assoc 1999; 94: 496–503.

    Article  Google Scholar 

  12. Cheson BD, Bennett JM, Kantarjian H, Pinto A, Schiffer CA, Nimer SD et al. Report of an international working group to standardize response criteria for myelodysplastic syndromes. Blood 2000; 96: 3671–3674.

    CAS  PubMed  Google Scholar 

  13. de Lima M, Padua L, Giralt S, Hosing C, Komanduri K, Qazilbash M et al. A dose and schedule finding study of maintenance therapy with low-dose 5-azacitidine (AZA) after allogeneic hematopoietic stem cell transplantation (HSCT) for high-risk AML or MDS. Blood 2007; 110: 3012 (abstract 3012).

    Google Scholar 

  14. Aoudjhane M, Labopin M, Gorin NC, Shimoni A, Ruutu T, Kolb HJ et al. Comparative outcome of reduced intensity and myeloablative conditioning regimens in HLA identical sibling allogeneic hematopoietic stem cell transplantation for patients older than 50 years with acute myeloblastic leukemia: a retrospective survey from the acute leukemia working party of the European group for blood and marrow transplantation. Leukemia 2005; 19: 2304–2312.

    Article  CAS  PubMed  Google Scholar 

  15. Martino R, Valcarcel D, Brunet S, Sureda A, Sierra J . Comparable non-relapse mortality and survival after HLA-identical sibling blood stem cell transplantation with reduced or conventional-intensity preoparative regimens for high-risk myelodysplasia or acute myeloid leukemia in first remission. Bone Marrow Transplant 2008; 41: 33–38.

    Article  CAS  PubMed  Google Scholar 

  16. Parker JE, Shafi T, Pagliuca A, Mijovic A, Devereus S, Potter M et al. Allogeneic stem cell transplantation in the myelodysplastic syndromes: interim results of outcome following reduced-intensity conditioning compared with standard preparative regimens. Br J Haematol 2002; 119: 144–154.

    Article  PubMed  Google Scholar 

  17. Solomon SR, Savani BN, Childs R, Montero A, Boss C, Read EJ et al. Improved outcome for peripheral blood stem cell transplantation for advanced primary myelodysplastic syndrome. Biol Blood Marrow Transplant 2005; 11: 619–626.

    Article  PubMed  Google Scholar 

  18. Nakamura R, Rodriguez R, Palmer J, Stein A, Naing A, Tsai N et al. Reduced-intensity conditioning for allogeneic hematopoietic stem cell transplantation with fludarabine and melphalan is associated with durable disease control in myelodysplastic syndrome. Bone Marrow Transplant 2007; 40: 843–850.

    Article  CAS  PubMed  Google Scholar 

  19. Chan GW, Foss FM, Klein AK, Sprague K, Miller KB et al. Reduced-intensity transplantation for patients with myelodysplastic syndrome achieves durable remission with less graft-versus-host disease. Biol Blood Marrow Transplant 2003; 9: 753–759.

    Article  PubMed  Google Scholar 

  20. Kröger N, Schetelig J, Zabelina T, Kruger W, Renges H, Stute N et al. A fludarabine-based dose-reduced conditioning regimen followed by allogeneic stem cell transplantation from related or unrelated donors in patients with myelodysplastic syndrome. Bone Marrow Transplant 2001; 28: 643–647.

    Article  PubMed  Google Scholar 

  21. Oran B, Giralt S, Saliba R, Hosing C, Popat U, Khouri I et al. Allogeneic hematopoietic stem cell transplantation for the treatment of high-risk acute myelogenous leukemia and myelodysplastic syndrome using reduced-intensity conditioning with fludarabine and melphalan. Biol Blood Marrow Transplant 2007; 13: 454–462.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Scott BL, Sandmaier BM, Storer B, Maris MB, Sorror ML, Maloney DG et al. Myeloablative vs nonmyeloablative allogeneic transplantation for patients with myelodysplastic syndrome or acute myelogenous leukemia with multilineage dysplasia: a retrospective analysis. Leukemia 2006; 20: 128–135.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to T Field or J Perkins.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Field, T., Perkins, J., Huang, Y. et al. 5-Azacitidine for myelodysplasia before allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 45, 255–260 (2010). https://doi.org/10.1038/bmt.2009.134

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2009.134

Keywords

This article is cited by

Search

Quick links