Efficacy of Azacitidine in De Novo and Relapsed Acute Myeloid Leukemia: A Retrospective Comparative Study

Abstract

Introduction: Azacitidine is a therapeutic alternative to low-dose cytarabine in patients with acute myeloid leukemia (AML) who are unfit for intensive chemotherapy. Patients and Methods: We retrospectively analyzed all AML patients treated with azacitidine at the University Hospital Zurich and the Kantonsspital Munsterlingen between January 2005 and December 2011. The primary end point was overall survival (OS). Results: Thirty-eight patients were included in the analysis. Twenty-one (55%) patients had newly diagnosed AML, 14 (37%) had relapsed AML, and 3 (8%) underwent bridging therapy before allogeneic stem-cell transplantation. Age at diagnosis was 72 years in the newly diagnosed cohort and 58 years in the relapsed cohort, 19 (50%) patients were female, 20 (53%) patients were transfusion dependent, and bone marrow blast count was 43% (interquartile range, 26-80). Most patients (58%) had poor or very poor risk AML. Patients received a median (range) of 7 (3-13) therapy cycles. The median (range) OS in the newly diagnosed and previously treated patient groups were 308 (175-580) days and 346 (293-628) days, respectively (P = .94). Median OS in the 3 patients treated before allogeneic stemcell transplantation has not been reached. Sixty-day mortality was 7.9%, with no difference between the 2 groups. Ongoing or increasing transfusion dependency was associated with adverse outcome (hazard ratio, 3.09; 95% confidence interval, 1.29-7.37, P = .011). Conclusion: Treatment with azacitidine led to a median OS of 10 months in both a previously untreated and a previously treated frail AML patient cohort. A positive effect in transfusion dependency was observed in 29% of these patients and was associated with better survival. AbstractIntroduction: Azacitidine is a therapeutic alternative to low-dose cytarabine in patients with

Hypomethylating agents in relapsed and refractory AML: outcomes and their predictors in a large international patient cohort

“…To our knowledge, this international study represents the largest reported experience of HMA use in patients with RR-AML. [8][9][10][16][17][18] As expected, patients in this cohort were older (median age 65 years) and exhibited high-risk disease features, such as poor-risk karyotypes (40%) and secondary AML (30%). Although the OS for the entire cohort was poor (median, 6.7 months), a significant subset of patients (16%) achieved CR/CRi with HMAs and achieved a median OS of 21.2 months (95% CI, 16.3-28.6).…”

“…1,2,7 The role of HMAs in patients with RR-AML after failure of IC is not well studied, with data limited to small and/or single-institution retrospective studies. [8][9][10] The objective of this international retrospective study was to examine the patterns of use and efficacy of HMAs in a multicenter cohort of RR-AML patients and to assess for clinical and laboratory markers that could identify patients most likely to benefit from HMAs.…”

Azacitidine–venetoclax versus azacitidine salvage treatment for primary induction failure or first relapsed acute myeloid leukaemia patients

“…The outcome of our historical control group is in line with published data. [2][3][4][5] For instance, the French DATAML registry reported 97 similar patients who achieved a 19% CR rate and a median OS of 9.6 months. 5 VEN-AZA salvage therapy has been reported in several publications.…”

“…The response rates in this population of patients are 15%-20% and the overall survival (OS) is approximately 7 months. [2][3][4][5] Therefore, new therapeutic strategies are needed. Venetoclax (VEN), an inhibitor of the antiapoptotic protein BCL-2, shows antileukemic activity by restoring intrinsic apoptosis in AML blasts.…”

Hypomethylating Agents for Treatment of Elderly Patients with Refractory Acute Myeloid Leukemia - A Case Report with a Focused Review of Literature

“…In addition, we found six other retrospective studies that used hypomethylating agents in patients with relapsed/refractory AML. In 2015, Gemueden et al (n = 14) reported a MOS of 11 months in patients who received AZA [ 15 ]. Itzykson et al studied the outcomes of patients with relapsed (n = 67) and refractory (n = 63) AML who received AZA [ 16 ].…”