Outcome of therapy-related myeloid neoplasms treated with azacitidine

• Published in: Journal of hematology and oncology Vol. 5; no. 1; p. 44
• Main Authors: Fianchi, Luana, Criscuolo, Marianna, Lunghi, Monia, Gaidano, Gianluca, Breccia, Massimo, Levis, Alessandro, Finelli, Carlo, Santini, Valeria, Musto, Pellegrino, Oliva, Esther N, Leoni, Pietro, Aloe Spiriti, Antonietta, D'Alò, Francesco, Hohaus, Stefan, Pagano, Livio, Leone, Giuseppe, Voso, Maria Teresa
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 01.08.2012; BioMed Central; BMC
• Subjects: Adult; Aged; Aged, 80 and over; Analysis; Antimetabolites, Antineoplastic - therapeutic use; Antimitotic agents; Antineoplastic agents; Azacitidine - therapeutic use; Cancer; Care and treatment; Chemotherapy; Chromosomes; Development and progression; DNA Methylation - drug effects; Drug therapy; Female; Hematology; Humans; Hypomethylating agents; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - mortality; Male; Medical records; Methylation; Middle Aged; Mortality; Myelodysplastic Syndromes - drug therapy; Myelodysplastic Syndromes - mortality; Neoplasms, Second Primary - drug therapy; Neoplasms, Second Primary - mortality; Oncology; Prognosis; Remission Induction; Retrospective Studies; Survival Rate; Therapy related myeloid neoplasms; Tumors; Italy
• ISSN: 1756-8722; 1756-8722
• DOI: 10.1186/1756-8722-5-44

Therapy-related myeloid neoplasms (t-MN), including myelodysplastic syndromes and acute myeloid leukemia (t-MDS and t-AML) are associated to clinical and biologic unfavorable prognostic features, including high levels of DNA methylation. We retrospectively evaluated 50 t-MN patients (34 MDS and 16 AML) selected among all patients receiving azacitidine (AZA) at 10 Italian Hematology Centers. Patients had developed a t-MN at a median of 6.5 years (range 1.7- 29) after treatment of the primary tumor (hematological neoplasm, 27 patients; solid tumor, 23 patients). The overall response rate was 42% (complete remission: 10 patients, partial remission: 2 and hematological improvement: 8 patients) and was obtained after a median of 3 cycles (range 1-6). Median overall survival (OS) was 21 months (range 1-53.6+) from AZA start. OS was significantly better in patients with less than 20% blasts, in normal karyotype t-AML and when AZA was used as front-line treatment. This was confirmed by the multivariate analysis. This study reports efficacy of AZA in the largest series of therapy-related MN patients treated with 5-AZA. Our data show that blasts and karyotype maintain their important prognostic role in t-MN also in the azacitidine era.