Outcome of therapy-related myeloid neoplasms treated with azacitidine
1 Istituto di Ematologia, Università Cattolica del Sacro Cuore, 00168, Roma, Italy
2 Ematologia, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale Amedeo Avogadro, Novara, Italy
3 Ematologia, Università La Sapienza, Roma, Italy
4 Ospedale di Alessandria, Alessandria, Italy
5 Universita' di Bologna, Bologna, Italy
6 Ematologia Firenze, Firenze, Italy
7 Dipartimento Onco-Ematologico, IRCCS, Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
8 Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
9 Ematologia Ancona, Ancona, Italy
10 Ospedale Sant’Andrea, Roma, Italy
Journal of Hematology & Oncology 2012, 5:44 doi:10.1186/1756-8722-5-44Published: 1 August 2012
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.