In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 15_suppl ( 2012-05-20), p. 6534-6534
Abstract:
6534 Background: Until the early 2000s, treatment prior to SCT varied according to cytogenetics and % BM blasts and was mainly induction-type chemotherapy (ICT). The role of Azacitidine (AZA) prior to transplant remains uncertain. Methods: 163 consecutive pts (M/F=104/67; age 〉 18) underwent alloSCT between 2005 and 2009 from sibling (n=96) or HLA- allele-MUD (10/10) (n=67). The SC source was blood (n=142) or marrow (n=21) and conditionings were myeloablative (n=33); nonmyeloablative (n=130). Pts who did not received neither prior ICT nor AZA were excluded since the main objective of this study was to investigate the impact of prior therapy on pts’ outcome. Results: At diagnosis, FAB/WHO was: 24 RA/RARS/RCMD, 52 RAEB-1, 74 RAEB-2, 13 RAEB-t/AML; Cytogenetic: fav (n=93), int (n=32), unfav (n=37). 98 pts received prior ICT (ICT-group) and 65 had received AZA, either alone (AZA-group; n=48) or AZA preceded or followed by intensive CT (AZA-chemo-group; n=17). In AZA groups, the drug was started 38 to 941 days from transplant and discontinued 6 to 438 days before transplant with a median number of 4 cycles (range 1-26). Overall, 119 pts were considered responders at SCT (CR, PR, mCR), including 33 (69%) treated with AZA-alone, 9 (53%) with AZA-chemo and 77(78%) with ICT.While there were no differences between AZA-group and ICT-group in terms of OS, EFS, relapse and NRM, having a poor risk cytogenetic and receiving AZA-chemo prior to SCT were, in multivariate analyses, the most important factors that adversely influenced OS with [HR=3.03; 95% CI 1.84-4.96] (p 〈 .0001) and [HR=2.72; 95% CI, 1.38-5.35] (p=.004), respectively. Pts of AZA-chemo group had the same rate of relapse but significantly higher NRM rate (p=.059) than those who received either AZA or ICT alone. Conclusions: With the goal of down-staging underlying disease before allo-SCT, AZA treatment appears to be a valid therapeutic approach, but mainly in pts receiving AZA alone with an outcome at least equivalent to pts receiving ICT prior to SCT. Allo-SCT in pts who required both AZA and chemotherapy had less satisfactory outcomes, possibly reflecting additional toxicity and/or more resistant disease.
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/jco.2012.30.15_suppl.6534
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2012
detail.hit.zdb_id:
2005181-5
