Comparative analysis of hypomethylating agents as maintenance therapy after allogeneic hematopoietic stem cell transplantation for high-risk acute leukemia

Abstract

We retrospectively analyzed the outcomes of 136 consecutive patients who received allogeneic hematopoietic stem cell transplantation (allo-HSCT) at our center. Among them, 76 cases used hypomethylating agents (decitabine, n = 40; azacitidine, n = 36) as post-transplant maintenance therapy, whereas 60 contemporaneous patients did not adopt maintenance therapy. The 3-year incidences of relapse in two groups were 16.6% and 39.2% (p = .001). The 3-year OS and DFS in maintenance group were 84.0% and 78.6%, which were remarkably improved than in control group (60.0% and 58.0%) (p = .004, p = .011). Moreover, the 3-year relapse rates for patients receiving decitabine and azacitidine therapy were 8.5% and 25.0%, respectively (p = .019). Patients utilizing decitabine had more common possibility of grade 3–4 neutropenia than azacitidine (20.0% vs. 2.8%, p = .031). These results indicate that maintenance therapies using hypomethylating agents could reduce the risk of post-transplant recurrence, resulting into remarkable superior survival. Decitabine might lower relapse after allo-HSCT with somewhat more severe myelosuppression when being compared to azacitidine.

Keywords:

• Allogeneic hematopoietic stem cell transplantation
• maintenance therapy
• relapse
• decitabine
• azacitidine

Acknowledgements

The present work was supported and funded by the National Natural Science Foundation of China (No. 81900181), Key Scientific Research Project of Henan University (Nos. 20A320021 and 22A320017), Joint Co-construction Project of Henan Medical Technology Research Plan (No. 2018020028), and Key Science and Technology Project of Henan Province (No. SBGJ202103054).

Author contributions

Wang Ma and Dingming Wan designed the research study; Li Li, Ran Zhang, and Weijie Cao collected and analyzed the data; Zhilei Bian, Yang Qin, Rong Guo, Suping Zhang, and Yingnan Peng wrote the paper and revised the paper. All authors read and approved the final manuscript.

Disclosure statement

The authors declare no relevant conflict of interest.

Additional information

Funding

The present work was supported and funded by the National Natural Science Foundation of China (No. 81900181), Key Scientific Research Project of Henan University (Nos. 20A320021 and 22A320017), Joint Co-construction Project of Henan Medical Technology Research Plan (No. 2018020028), and Key Science and Technology Project of Henan Province (No. SBGJ202103054).