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Low-dose 5-azacytidine as preventive therapy for relapse of AML and MDS following allogeneic HCT

Bone Marrow Transplantation volume 52, pages 918–921 (2017)Cite this article

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Relapse after allogeneic hematopoietic cell transplantation (allo-HCT) for AML or myelodysplastic syndrome (MDS) remains the main cause of treatment failure, and is associated with a poor prognosis and short survival regardless of salvage therapy.1

There are very few treatment modalities for this indication, including reduction/withdrawal of immunosuppressive therapy, chemotherapy with or without the infusion of donor lymphocytes, or a second allo-HCT, but results have been disappointing.2, 3 Therefore, there is an unmet need for novel and more effective therapies. This also applies to the setting of prevention of relapse. Limited data exist regarding the efficacy of 5-azacytidine in the setting of post-allograft relapses.4, 5 The data can be supported by experimental studies, showing that hypomethylating agents can induce functional suppressor function of regulatory T cells, mitigating GvHD without impairing GvL effect.6 We hypothesized that early administration of low-dose 5-azacytidine after allo-HCT might help reduce relapse in patients with high-risk myeloid malignancies.

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Acknowledgements

We thank the nursing staff for providing excellent care for our patients and the physicians in the Hematology and Oncology division at the American University of Beirut Medical Center, and referring physicians from Lebanon and the Middle East region for their significant contributions and dedicated patients’ care.

Author contributions

JEC contributed to the study design, collected and analyzed the data, performed statistical analysis, provided clinical care, and wrote and revised the manuscript. R Massoud and EF collected the data and edited the manuscript. MC performed statistical analysis and commented on the manuscript. NK is in charge of the cell therapy facility that collected and delivered the blood cell grafts infused into patients included in this analysis, and commented on the manuscript. R Mahfouz performed the molecular analysis and edited the manuscript. MAK-D contributed to the study design, provided clinical care and edited the manuscript. AB designed the transplant program, contributed to the study design, recruited patients, provided clinical care and edited the manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine, Bone Marrow Transplantation Program, American University of Beirut Medical Center, Beirut, Lebanon

    J El-Cheikh, R Massoud, E Fares, M Charafeddine & A Bazarbachi

  2. Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon

    N Kreidieh & R Mahfouz

  3. Department of Blood and Marrow Transplantation, H Lee Moffitt Cancer Center, Tampa, FL, USA

    M A Kharfan-Dabaja

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  1. J El-Cheikh
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  2. R Massoud
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  6. M Charafeddine
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  7. M A Kharfan-Dabaja
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  8. A Bazarbachi
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Correspondence to J El-Cheikh.

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El-Cheikh, J., Massoud, R., Fares, E. et al. Low-dose 5-azacytidine as preventive therapy for relapse of AML and MDS following allogeneic HCT. Bone Marrow Transplant 52, 918–921 (2017). https://doi.org/10.1038/bmt.2017.31

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