Azacitidine for treatment of imminent relapse in MDS or AML patients after allogeneic HSCT: results of the RELAZA trial

This study evaluated azacitidine as treatment of minimal residual disease (MRD) determined by a sensitive donor chimerism analysis of CD34 + blood cells to pre-empt relapse in patients with CD34 + myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) after allogeneic hematopoietic stem cel...

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Veröffentlicht in:Leukemia 2012-03, Vol.26 (3), p.381-389
Hauptverfasser: Platzbecker, U, Wermke, M, Radke, J, Oelschlaegel, U, Seltmann, F, Kiani, A, Klut, I-M, Knoth, H, Röllig, C, Schetelig, J, Mohr, B, Graehlert, X, Ehninger, G, Bornhäuser, M, Thiede, C
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container_start_page 381
container_title Leukemia
container_volume 26
creator Platzbecker, U
Wermke, M
Radke, J
Oelschlaegel, U
Seltmann, F
Kiani, A
Klut, I-M
Knoth, H
Röllig, C
Schetelig, J
Mohr, B
Graehlert, X
Ehninger, G
Bornhäuser, M
Thiede, C
description This study evaluated azacitidine as treatment of minimal residual disease (MRD) determined by a sensitive donor chimerism analysis of CD34 + blood cells to pre-empt relapse in patients with CD34 + myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (HSCT). At a median of 169 days after HSCT, 20/59 prospectively screened patients experienced a decrease of CD34 + donor chimerism to
doi_str_mv 10.1038/leu.2011.234
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At a median of 169 days after HSCT, 20/59 prospectively screened patients experienced a decrease of CD34 + donor chimerism to &lt;80% and received four azacitidine cycles (75 mg/m 2 /day for 7 days) while in complete hematologic remission. A total of 16 patients (80%) responded with either increasing CD34 + donor chimerism to ⩾80% ( n =10; 50%) or stabilization ( n =6; 30%) in the absence of relapse. Stabilized patients and those with a later drop of CD34 + donor chimerism to &lt;80% after initial response were eligible for subsequent azacitidine cycles. A total of 11 patients (55%) received a median of 4 (range, 1–11) additional cycles. Eventually, hematologic relapse occurred in 13 patients (65%), but was delayed until a median of 231 days (range, 56–558) after initial decrease of CD34 + donor chimerism to &lt;80%. In conclusion, pre-emptive azacitidine treatment has an acceptable safety profile and can substantially prevent or delay hematologic relapse in patients with MDS or AML and MRD after allogeneic HSCT.</description><identifier>ISSN: 0887-6924</identifier><identifier>EISSN: 1476-5551</identifier><identifier>DOI: 10.1038/leu.2011.234</identifier><identifier>PMID: 21886171</identifier><identifier>CODEN: LEUKED</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>Adult ; Aged ; Antimetabolites, Antineoplastic - adverse effects ; Antimetabolites, Antineoplastic - therapeutic use ; Azacitidine - adverse effects ; Azacitidine - therapeutic use ; Biological and medical sciences ; Bone marrow ; Cancer ; Cancer Research ; Care and treatment ; Chimerism ; Clinical trials ; Creatinine ; Critical Care Medicine ; Female ; Follow-Up Studies ; Graft versus host disease ; Hematologic and hematopoietic diseases ; Hematology ; Hematopoietic Stem Cell Transplantation ; Hematopoietic stem cells ; Humans ; Intensive ; Internal Medicine ; Leading ; leading-article ; Leukemia ; Leukemia, Myeloid, Acute - drug therapy ; Leukemia, Myeloid, Acute - mortality ; Leukemia, Myeloid, Acute - therapy ; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis ; Male ; Medical sciences ; Medicine ; Medicine &amp; Public Health ; Middle Aged ; Myelodysplastic syndromes ; Myelodysplastic Syndromes - drug therapy ; Myelodysplastic Syndromes - mortality ; Myelodysplastic Syndromes - therapy ; Neoplasm, Residual - therapy ; Oncology ; Recurrence ; Relapse ; Remission (Medicine) ; Stem cell transplantation ; Time Factors ; Transplantation ; Transplantation, Homologous ; Treatment Outcome ; Young Adult</subject><ispartof>Leukemia, 2012-03, Vol.26 (3), p.381-389</ispartof><rights>The Author(s) 2012</rights><rights>2015 INIST-CNRS</rights><rights>COPYRIGHT 2012 Nature Publishing Group</rights><rights>Copyright Nature Publishing Group Mar 2012</rights><rights>Copyright © 2012 Macmillan Publishers Limited 2012 Macmillan Publishers Limited</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c674t-d179839837f847e4f32d031aef317aa4c832c55e9946c7f3eab653af0a4745a03</citedby><cites>FETCH-LOGICAL-c674t-d179839837f847e4f32d031aef317aa4c832c55e9946c7f3eab653af0a4745a03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/leu.2011.234$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/leu.2011.234$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=25702888$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21886171$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Platzbecker, U</creatorcontrib><creatorcontrib>Wermke, M</creatorcontrib><creatorcontrib>Radke, J</creatorcontrib><creatorcontrib>Oelschlaegel, U</creatorcontrib><creatorcontrib>Seltmann, F</creatorcontrib><creatorcontrib>Kiani, A</creatorcontrib><creatorcontrib>Klut, I-M</creatorcontrib><creatorcontrib>Knoth, H</creatorcontrib><creatorcontrib>Röllig, C</creatorcontrib><creatorcontrib>Schetelig, J</creatorcontrib><creatorcontrib>Mohr, B</creatorcontrib><creatorcontrib>Graehlert, X</creatorcontrib><creatorcontrib>Ehninger, G</creatorcontrib><creatorcontrib>Bornhäuser, M</creatorcontrib><creatorcontrib>Thiede, C</creatorcontrib><title>Azacitidine for treatment of imminent relapse in MDS or AML patients after allogeneic HSCT: results of the RELAZA trial</title><title>Leukemia</title><addtitle>Leukemia</addtitle><addtitle>Leukemia</addtitle><description>This study evaluated azacitidine as treatment of minimal residual disease (MRD) determined by a sensitive donor chimerism analysis of CD34 + blood cells to pre-empt relapse in patients with CD34 + myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (HSCT). At a median of 169 days after HSCT, 20/59 prospectively screened patients experienced a decrease of CD34 + donor chimerism to &lt;80% and received four azacitidine cycles (75 mg/m 2 /day for 7 days) while in complete hematologic remission. A total of 16 patients (80%) responded with either increasing CD34 + donor chimerism to ⩾80% ( n =10; 50%) or stabilization ( n =6; 30%) in the absence of relapse. Stabilized patients and those with a later drop of CD34 + donor chimerism to &lt;80% after initial response were eligible for subsequent azacitidine cycles. A total of 11 patients (55%) received a median of 4 (range, 1–11) additional cycles. Eventually, hematologic relapse occurred in 13 patients (65%), but was delayed until a median of 231 days (range, 56–558) after initial decrease of CD34 + donor chimerism to &lt;80%. 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Malignant lymphomas. Malignant reticulosis. 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Wermke, M ; Radke, J ; Oelschlaegel, U ; Seltmann, F ; Kiani, A ; Klut, I-M ; Knoth, H ; Röllig, C ; Schetelig, J ; Mohr, B ; Graehlert, X ; Ehninger, G ; Bornhäuser, M ; Thiede, C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c674t-d179839837f847e4f32d031aef317aa4c832c55e9946c7f3eab653af0a4745a03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antimetabolites, Antineoplastic - adverse effects</topic><topic>Antimetabolites, Antineoplastic - therapeutic use</topic><topic>Azacitidine - adverse effects</topic><topic>Azacitidine - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Bone marrow</topic><topic>Cancer</topic><topic>Cancer Research</topic><topic>Care and treatment</topic><topic>Chimerism</topic><topic>Clinical trials</topic><topic>Creatinine</topic><topic>Critical Care Medicine</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Graft versus host disease</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Hematology</topic><topic>Hematopoietic Stem Cell Transplantation</topic><topic>Hematopoietic stem cells</topic><topic>Humans</topic><topic>Intensive</topic><topic>Internal Medicine</topic><topic>Leading</topic><topic>leading-article</topic><topic>Leukemia</topic><topic>Leukemia, Myeloid, Acute - drug therapy</topic><topic>Leukemia, Myeloid, Acute - mortality</topic><topic>Leukemia, Myeloid, Acute - therapy</topic><topic>Leukemias. 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source MEDLINE; Nature Journals Online; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; SpringerLink Journals - AutoHoldings
subjects Adult
Aged
Antimetabolites, Antineoplastic - adverse effects
Antimetabolites, Antineoplastic - therapeutic use
Azacitidine - adverse effects
Azacitidine - therapeutic use
Biological and medical sciences
Bone marrow
Cancer
Cancer Research
Care and treatment
Chimerism
Clinical trials
Creatinine
Critical Care Medicine
Female
Follow-Up Studies
Graft versus host disease
Hematologic and hematopoietic diseases
Hematology
Hematopoietic Stem Cell Transplantation
Hematopoietic stem cells
Humans
Intensive
Internal Medicine
Leading
leading-article
Leukemia
Leukemia, Myeloid, Acute - drug therapy
Leukemia, Myeloid, Acute - mortality
Leukemia, Myeloid, Acute - therapy
Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis
Male
Medical sciences
Medicine
Medicine & Public Health
Middle Aged
Myelodysplastic syndromes
Myelodysplastic Syndromes - drug therapy
Myelodysplastic Syndromes - mortality
Myelodysplastic Syndromes - therapy
Neoplasm, Residual - therapy
Oncology
Recurrence
Relapse
Remission (Medicine)
Stem cell transplantation
Time Factors
Transplantation
Transplantation, Homologous
Treatment Outcome
Young Adult
title Azacitidine for treatment of imminent relapse in MDS or AML patients after allogeneic HSCT: results of the RELAZA trial
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