Conditioning regimen intensity and low-dose azacitidine maintenance after allogeneic hematopoietic cell transplantation for acute myeloid leukemia

Abstract

Azacitidine (AZA) maintenance following allogeneic hematopoietic cell transplantation (HCT) for acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) may reduce relapse risk and improve survival. Given logistic and toxicity-related challenges, identifying subgroups appropriate for this approach is an unmet need. Using data from two centers, we retrospectively compared event-free survival (EFS) and overall survival (OS) of AML and MDS patients who received AZA maintenance (n = 59) with historic controls (n = 90). Controls were selected according to the following criteria: no death, relapse, or Grade III–IV acute GVHD for 100 days after transplant. In multivariable analysis, AZA maintenance yielded significantly improved EFS (p = 0.019) and OS (p = 0.011). Outcomes differed according to regimen intensity. For reduced-intensity transplant, EFS (p = 0.004) and OS (p = 0.004) were significantly improved and equivalent to myeloablative transplant. A significant benefit following myeloablative transplant was not observed. Within the limitation of its retrospective nature, this study suggests that AZA maintenance improves outcomes following reduced-intensity HCT, comparable to myeloablative HCT.

Keywords:

• Azacitidine maintenance
• acute myeloid leukemia
• myelodysplastic syndrome
• hematopoietic cell transplantation

Acknowledgements

The authors thank the physicians and staff members at both institutions for providing and contributing to data collection.

Authors’ contributions

N.A., S.M., and M.D.L. designed the study. N.A. and S.M. collected data for the study. Statistical analysis was performed by N.A., P.F., and S.C. Manuscript was prepared by N.A. and M.D.L. B.T. and S.M. provided critical comments and reviews. All authors contributed to and approved the final version of the manuscript.

Disclosure statement

M.D.L., research funding and consulting, Celgene. The remaining authors declare no competing conflicts of interest.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, M.D.L.