A multi-center study of 93 patients with higher-risk MDS or low blast count AML demonstrated that induction with azacitidine (AZA) is a feasible “bridge to transplant,” with 52% of patients able to undergo HCT. In the study, patients received between 4 and 12 cycles of AZA, 75 mg/m2/day, 7 days/month, at a median of 0.8 months (range, 0-105 months) from initial MDS diagnosis.
At a median of 4.5 cycles (range 1-11), 25% of patients (n=19) achieved complete remission (CR), 3% marrow-CR (n=2), 14% partial remission (PR, n=11), 9% hematologic improvement (HI, n=7), 35% had stable disease (SD, n=27) and 14% progressive disease (PD, n=11). Fifty-two percent (n=48) underwent HCT, after a median of 4.5 AZA cycles (range, 1-11). Forty-five patients did not receive HCT due to disease relapse or progression (n=16, 35%), adverse events (n=12, 27%), refusal (n=5, 11%), or other causes (n=12, 27%).
At a median follow-up of 18.5 months (range 0.2-31.5), 43 patients are alive (25 received HCT), and 50 patients died. HCT considered as time-dependent covariate was associated to a significantly longer survival (HR 0.4, 95% CI: 0.2-0.8, p=0.008). The researchers noted that these data compare favorably with previous studies in MDS on HCT preceded by conventional chemotherapy, and that their results also confirmed that disease status at the time of HCT remains a significant prognostic factor in survival when using hypomethylating agents.