Maintenance azacitidine after myeloablative allogeneic hematopoietic cell transplantation for myeloid malignancies

Abstract

Allogeneic hematopoietic cell transplantation (HCT) is a curative option for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS), but carries a high risk of relapse. This retrospective review evaluates the effectiveness of maintenance azacitidine in high-risk AML and MDS patients to reduce the probability of relapse. Twenty-five patients who received maintenance azacitidine were matched to historical controls in a two-to-one ratio based on diagnosis, donor type, conditioning regimen intensity, and age. Over 90% of patients received myeloablative conditioning. There was no difference in time to hematologic relapse, overall survival, or non-relapse mortality. Maintenance therapy was stopped early in 72% of patients due to graft-versus-host-disease, relapse, infection, and intolerance (13 of 25 patients received less than 4 cycles). There was a trend towards higher toxicity in the azacitidine group. The use of prophylactic azacitidine following myeloablative allogeneic HCT outside a clinical trial cannot be recommended at this time.

Keywords:

• Acute myeloid leukemia
• myelodysplastic syndrome
• allogeneic transplantation
• maintenance chemotherapy
• azacitidine

Acknowledgements

The authors thank Dr. Harold Chung, Dr. William Clark, Dr. Gary Simmons, and Dr. Christina Wiedl for their support and comprehensive care of these patients.

Dr. Sabo was supported by the Virginia Commonwealth University Massey Cancer Center Biostatistics Shared Resource, which is funded from NIH-NCI Cancer Center Support Grant P30 CA016059.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at https://doi.org/10.1080/10428194.2018.1443334.