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Auger N, Douet-Guilbert N, Quessada J, Theisen O, Lafage-Pochitaloff M, Troadec MB. Cytogenetics in the management of myelodysplastic neoplasms (myelodysplastic syndromes, MDS): Guidelines from the groupe francophone de cytogénétique hématologique (GFCH). Curr Res Transl Med 2023; 71:103409. [PMID: 38091642 DOI: 10.1016/j.retram.2023.103409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/04/2023] [Accepted: 09/14/2023] [Indexed: 12/26/2023]
Abstract
Myelodysplastic neoplasms (MDS) are clonal hematopoietic neoplasms. Chromosomal abnormalities (CAs) are detected in 40-45% of de novo MDS and up to 80% of post-cytotoxic therapy MDS (MDS-pCT). Lately, several changes appeared in World Health Organization (WHO) classification and International Consensus Classification (ICC). The novel 'biallelic TP53 inactivation' (also called 'multi-hit TP53') MDS entity requires systematic investigation of TP53 locus (17p13.1). The ICC maintains CA allowing the diagnosis of MDS without dysplasia (del(5q), del(7q), -7 and complex karyotype). Deletion 5q is the only CA, still representing a low blast class of its own, if isolated or associated with one additional CA other than -7 or del(7q) and without multi-hit TP53. It represents one of the most frequent aberrations in adults' MDS, with chromosome 7 aberrations, and trisomy 8. Conversely, translocations are rarer in MDS. In children, del(5q) is very rare while -7 and del(7q) are predominant. Identification of a germline predisposition is key in childhood MDS. Aberrations of chromosomes 5, 7 and 17 are the most frequent in MDS-pCT, grouped in complex karyotypes. Despite the ever-increasing importance of molecular features, cytogenetics remains a major part of diagnosis and prognosis. In 2022, a molecular international prognostic score (IPSS-M) was proposed, combining the prognostic value of mutated genes to the previous scoring parameters (IPSS-R) including cytogenetics, still essential. A karyotype on bone marrow remains mandatory at diagnosis of MDS with complementary molecular analyses now required. Analyses with FISH or other technologies providing similar information can be necessary to complete and help in case of karyotype failure, for doubtful CA, for clonality assessment, and for detection of TP53 deletion to assess TP53 biallelic alterations.
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Affiliation(s)
- Nathalie Auger
- Gustave Roussy, Génétique des tumeurs, 144 rue Edouard Vaillant, Villejuif 94805, France
| | - Nathalie Douet-Guilbert
- Univ Brest, Inserm, EFS, UMR 1078, GGB, Brest F-29200, France; CHRU Brest, Laboratoire de Génétique Chromosomique, Service de génétique, Brest, France
| | - Julie Quessada
- Laboratoire de Cytogénétique Hématologique, CHU Timone Aix Marseille University, Marseille, France
| | - Olivier Theisen
- Hematology Biology, Nantes University Hospital, Nantes, France
| | | | - Marie-Bérengère Troadec
- Univ Brest, Inserm, EFS, UMR 1078, GGB, Brest F-29200, France; CHRU Brest, Laboratoire de Génétique Chromosomique, Service de génétique, Brest, France.
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Okamoto H, Inoue Y, Miyashita A, Kawaji-Kanayama Y, Chinen S, Fujino T, Tsukamoto T, Shimura Y, Mizutani S, Kaneko H, Kuwahara-Ota S, Fuchida SI, Nishiyama D, Hirakawa K, Uchiyama H, Uoshima N, Kawata E, Kuroda J. Real-world practice-based prognostic model for higher-risk myelodysplastic syndromes treated with azacitidine monotherapy: The Kyoto prognostic scoring system. Int J Hematol 2023; 118:323-332. [PMID: 37378717 DOI: 10.1007/s12185-023-03627-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/14/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023]
Abstract
The prognostic impact of patient-related factors, including age, nutritional parameters, and inflammation status, in higher-risk myelodysplastic syndromes (HR-MDS) has been largely unexplored. This multicenter retrospective study aimed to establish a real-world practice-based prognostic model for HR-MDS by considering both disease- and patient-related parameters in 233 patients treated with AZA monotherapy at seven institutions. We found that anemia, presence of circulating blasts in peripheral blood, low absolute lymphocyte count, low total cholesterol (T-cho) and albumin serum levels, complex karyotype, and del(7q) or - 7 were poor prognostic factors. Therefore, we developed a new prognostic model called the Kyoto Prognostic Scoring System (KPSS) by incorporating the two variables with the highest C-indexes (complex karyotype and serum T-cho level). The KPSS classified patients into the following three groups: good (0 risk factors), intermediate (1), and poor (2). Median overall survival for these groups was 24.4, 11.3, and 6.9, respectively (p < 0.001). The discriminatory power of the KPSS was higher than that of the traditional International Prognostic Scoring System. In conclusion, we identified several nutritional parameters with prognostic relevance in patients with HR-MDS and generated a prognostic model consisting of complex karyotype and serum T-cho level that enabled excellent risk stratification.
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Affiliation(s)
- Haruya Okamoto
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
| | - Yu Inoue
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
| | - Akihiro Miyashita
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
| | - Yuka Kawaji-Kanayama
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
| | - Shotaro Chinen
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
| | - Takahiro Fujino
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
| | - Taku Tsukamoto
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
| | - Yuji Shimura
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
| | - Shinsuke Mizutani
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
| | - Hiroto Kaneko
- Division of Hematology, Aiseikai Yamashina Hospital, Kyoto, Japan
| | - Saeko Kuwahara-Ota
- Division of Hematology, Japan Community Health Care Organization Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Shin-Ichi Fuchida
- Division of Hematology, Japan Community Health Care Organization Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | | | - Koichi Hirakawa
- Division of Hematology, Fukuchiyama City Hospital, Kyoto, Japan
| | - Hitoji Uchiyama
- Division of Hematology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
| | - Nobuhiko Uoshima
- Division of Hematology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Eri Kawata
- Division of Hematology, Matsushita Memorial Hospital, Moriguchi, Japan
| | - Junya Kuroda
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan.
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Abstract
Myelodysplastic syndromes (MDS) are a family of myeloid cancers with diverse genotypes and phenotypes characterized by ineffective haematopoiesis and risk of transformation to acute myeloid leukaemia (AML). Some epidemiological data indicate that MDS incidence is increasing in resource-rich regions but this is controversial. Most MDS cases are caused by randomly acquired somatic mutations. In some patients, the phenotype and/or genotype of MDS overlaps with that of bone marrow failure disorders such as aplastic anaemia, paroxysmal nocturnal haemoglobinuria (PNH) and AML. Prognostic systems, such as the revised International Prognostic Scoring System (IPSS-R), provide reasonably accurate predictions of survival at the population level. Therapeutic goals in individuals with lower-risk MDS include improving quality of life and minimizing erythrocyte and platelet transfusions. Therapeutic goals in people with higher-risk MDS include decreasing the risk of AML transformation and prolonging survival. Haematopoietic cell transplantation (HCT) can cure MDS, yet fewer than 10% of affected individuals receive this treatment. However, how, when and in which patients with HCT for MDS should be performed remains controversial, with some studies suggesting HCT is preferred in some individuals with higher-risk MDS. Advances in the understanding of MDS biology offer the prospect of new therapeutic approaches.
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Leisch M, Pfeilstöcker M, Stauder R, Heibl S, Sill H, Girschikofsky M, Stampfl-Mattersberger M, Tinchon C, Hartmann B, Petzer A, Schreder M, Kiesl D, Vallet S, Egle A, Melchardt T, Piringer G, Zebisch A, Machherndl-Spandl S, Wolf D, Keil F, Drost M, Greil R, Pleyer L. Adverse Events in 1406 Patients Receiving 13,780 Cycles of Azacitidine within the Austrian Registry of Hypomethylating Agents-A Prospective Cohort Study of the AGMT Study-Group. Cancers (Basel) 2022; 14:cancers14102459. [PMID: 35626063 PMCID: PMC9140081 DOI: 10.3390/cancers14102459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Azacitidine is thus far the only drug shown to prolong overall survival and is, therefore, the recommended (backbone) treatment in patients diagnosed with myelodysplastic syndromes, chronic myelomonocytic leukemia and acute myeloid leukemia who are not eligible for intensive chemotherapy. Detailed reports on adverse events are often lacking. We performed a thorough analysis of the adverse events that occur during treatment with azacitidine in the largest cohort of patients treated with this drug published so far. We also compared the frequency of adverse events documented in our cohort to published data from randomized clinical trials with an azacitidine monotherapy arm. Adverse event documentation in the Austrian Registry was high. Hematologic adverse events occurred at a similar rate compared to published trials, whereas gastrointestinal toxicities were significantly less commonly reported. Our data complement results from clinical trials with real-world evidence and form a reference for future combination strategies with azacitidine. Abstract Background: Azacitidine is the treatment backbone for patients with acute myeloid leukemia, myelodysplastic syndromes and chronic myelomonocytic leukemia who are considered unfit for intensive chemotherapy. Detailed reports on adverse events in a real-world setting are lacking. Aims: To analyze the frequency of adverse events in the Austrian Registry of Hypomethylating agents. To compare real-world data with that of published randomized clinical trials. Results: A total of 1406 patients uniformly treated with a total of 13,780 cycles of azacitidine were analyzed. Hematologic adverse events were the most common adverse events (grade 3–4 anemia 43.4%, grade 3–4 thrombopenia 36.8%, grade 3–4 neutropenia 36.1%). Grade 3–4 anemia was significantly more common in the Registry compared to published trials. Febrile neutropenia occurred in 33.4% of patients and was also more common in the Registry than in published reports. Other commonly reported adverse events included fatigue (33.4%), pain (29.2%), pyrexia (23.5%), and injection site reactions (23.2%). Treatment termination due to an adverse event was rare (5.1%). Conclusion: The safety profile of azacitidine in clinical trials is reproducible in a real-world setting. With the use of prophylactic and concomitant medications, adverse events can be mitigated and azacitidine can be safely administered to almost all patients with few treatment discontinuations.
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Affiliation(s)
- Michael Leisch
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
| | - Michael Pfeilstöcker
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 3rd Medical Department for Haematology and Oncology, Hanusch Hospital, 1140 Vienna, Austria
| | - Reinhard Stauder
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine V, Innsbruck Medical University, 6020 Innsbruck, Austria
| | - Sonja Heibl
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 4th Medical Department of Internal Medicine, Hematology, Internistic Oncology and Palliative Medicine, Klinikum Wels-Grieskirchen GmbH, 4600 Wels, Austria
| | - Heinz Sill
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Division of Hematology, Medical University of Graz, 8036 Graz, Austria
| | - Michael Girschikofsky
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 1st Medical Department, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH Elisabethinen, 4020 Linz, Austria
| | - Margarete Stampfl-Mattersberger
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine 2, Klinik Donaustadt, 1220 Vienna, Austria
| | - Christoph Tinchon
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department for Hemato-Oncology, LKH Hochsteiermark, 8700 Leoben, Austria
| | - Bernd Hartmann
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine, Landeskrankenhaus Feldkirch, 6800 Feldkirch, Austria
| | - Andreas Petzer
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Medical Oncology and Hematology, Internal Medicine I, Ordensklinikum Linz GmbH Barmherzige Schwestern, 4020 Linz, Austria
| | - Martin Schreder
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 1st Department of Internal Medicine, Center for Oncology and Hematology, Klinik Ottakring, 1160 Vienna, Austria
| | - David Kiesl
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Hematology and Medical Oncology, Kepleruniversitätsklinikum, 4020 Linz, Austria
| | - Sonia Vallet
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine 2, University Hospital Krems, Karl Landsteiner Private University of Health Sciences, 3500 Krems, Austria
| | - Alexander Egle
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
| | - Thomas Melchardt
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
| | - Gudrun Piringer
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 4th Medical Department of Internal Medicine, Hematology, Internistic Oncology and Palliative Medicine, Klinikum Wels-Grieskirchen GmbH, 4600 Wels, Austria
| | - Armin Zebisch
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Division of Hematology, Medical University of Graz, 8036 Graz, Austria
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, 8036 Graz, Austria
| | - Sigrid Machherndl-Spandl
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 1st Medical Department, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH Elisabethinen, 4020 Linz, Austria
| | - Dominik Wolf
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine V, Innsbruck Medical University, 6020 Innsbruck, Austria
| | - Felix Keil
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 3rd Medical Department for Haematology and Oncology, Hanusch Hospital, 1140 Vienna, Austria
| | - Manuel Drost
- Assign Data Management and Biostatistics GmbH, 6020 Innsbruck, Austria;
| | - Richard Greil
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
| | - Lisa Pleyer
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Correspondence:
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5
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Liu L, Jia M, Sun L, Tian W, Tang P, Jiang Z. Meta-analysis of the benefit of hypomethylating agents before allogeneic hematopoietic stem cell transplantation in myelodysplastic syndromes. Clin Exp Med 2021; 21:537-543. [PMID: 33866494 PMCID: PMC8505317 DOI: 10.1007/s10238-021-00712-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/07/2021] [Indexed: 12/15/2022]
Abstract
Hypomethylating agents (HMAs) are effective therapies in myelodysplastic syndromes (MDS), but allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only way to cure MDS. According to the current literature, it is difficult to confirm whether HMAs bridging therapy is beneficial for MDS patients receiving allo-HSCT. Therefore, we tried to evaluate the effect of HMAs on long-term survival of the MDS patients. Databases, including PubMed, Embase Ovid, and the Cochrane Library, were searched for studies published up to January 10, 2021. Patients who accepted HMAs bridging to allo-HSCT were defined as experimental group, while patients who received the best supportive care (BSC) before allo-HSCT were control group. Overall survival (OS) was the primary end point. Seven studies were included in the final analysis. The final results showed no OS differences between patients accepted HMAs before allo-HSCT and those received BSC (HR = 0.86, 95% CI: 0.64-1.15, p = 0.32), indicating that MDS patients' long-term survival did not benefit from HMAs bridging therapy before allo-HSCT. This conclusion needs to be further verified by a large number of prospective randomized controlled trials, which have guiding significance for the treatment of MDS patients.
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Affiliation(s)
- Liu Liu
- Department of Hematology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China.
| | - Menglu Jia
- Department of Hematology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Ling Sun
- Department of Hematology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Wenliang Tian
- Department of Hematology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Ping Tang
- Department of Hematology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Zhongxing Jiang
- Department of Hematology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
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Bouchla A, Thomopoulos TP, Papageorgiou SG, Apostolopoulou C, Loucari C, Mpazani E, Pappa V. Predicting outcome in higher-risk myelodysplastic syndrome patients treated with azacitidine. Epigenomics 2021; 13:1129-1143. [PMID: 34291653 DOI: 10.2217/epi-2021-0124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
5-Azacitidine (5-AZA) is widely used for the treatment of higher-risk myelodysplastic syndromes. However, response and survival rates vary considerably, while indicated treatment duration remains undefined. For these reasons, factors determining response and survival are of major importance. Clinical, morphological, flow cytometry, cytogenetic and molecular factors are discussed in this review. Biomarkers predictive of response and prognosis, as well as their link to the mode of action of 5-AZA are also addressed, shifting the focus from clinical practice to investigational research. Their use could further improve prognostic classification of 5-AZA treated higher-risk myelodysplastic syndromes in the near future.
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Affiliation(s)
- Anthi Bouchla
- Second Department of Internal Medicine & Research Unit Hematology Unit, University General Hospital Attikon, Rimini, 12462 Chaidari, Athens, Greece
| | - Thomas P Thomopoulos
- Second Department of Internal Medicine & Research Unit Hematology Unit, University General Hospital Attikon, Rimini, 12462 Chaidari, Athens, Greece
| | - Sotirios G Papageorgiou
- Second Department of Internal Medicine & Research Unit Hematology Unit, University General Hospital Attikon, Rimini, 12462 Chaidari, Athens, Greece
| | - Christina Apostolopoulou
- Second Department of Internal Medicine & Research Unit Hematology Unit, University General Hospital Attikon, Rimini, 12462 Chaidari, Athens, Greece
| | - Constantinos Loucari
- Second Department of Internal Medicine & Research Unit Hematology Unit, University General Hospital Attikon, Rimini, 12462 Chaidari, Athens, Greece
| | - Efthimia Mpazani
- Second Department of Internal Medicine & Research Unit Hematology Unit, University General Hospital Attikon, Rimini, 12462 Chaidari, Athens, Greece
| | - Vasiliki Pappa
- Second Department of Internal Medicine & Research Unit Hematology Unit, University General Hospital Attikon, Rimini, 12462 Chaidari, Athens, Greece
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Wan Z, Han B. High-dose regimens of hypomethylating agents promote transfusion independence in IPSS lower-risk myelodysplastic syndromes: a meta-analysis of prospective studies. Aging (Albany NY) 2021; 13:11120-11134. [PMID: 33818418 PMCID: PMC8109092 DOI: 10.18632/aging.202767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/14/2021] [Indexed: 04/28/2023]
Abstract
The hypomethylating agents (HMAs) azacytidine (AZA) and decitabine (DAC) are usually administered after the failure of erythropoietin-stimulating agents for lower-risk myelodysplastic syndromes (LR-MDS). However, it is unclear whether one of these HMAs has superior efficacy and safety. This was investigated in the present study by means of a meta-analysis of prospective studies published between January 1990 and July 2020 in PubMed, EMBASE, CENTRAL, and ClinicalTrials.gov databases; 19 studies with 1076 patients were included in the final analysis. The transfusion independence (TI) rate (66.7% [95% confidence interval: 41.7%-87.4%]) was higher with AZA 75 mg/m2/day for 7 days than with other regimens (all p<0.025). The proportion of patients with intermediate-1 risk influenced overall survival (p<0.05). There were no differences in treatment response, survival, and adverse event rates between patients treated with AZA (75 mg/m2/day for 5 days) and DAC (20 mg/m2/day for 3 days), although the latter group had a higher rate of grade 3/4 anemia (15.8% vs 0.0%; p<0.0001) and lower rate of diarrhea/constipation (6.9% vs 25.0%; p=0.002). Thus, both HMAs at high doses achieved reasonable response and TI rates with acceptable side effects, but did not prolong the overall survival in LR-MDS patients.
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Affiliation(s)
- Ziqi Wan
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, China
| | - Bing Han
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, China
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Diamantopoulos PT, Viniou NA. Factors affecting response to 5-azacytidine and prognosis of myelodysplastic syndrome. Is long-term survival a realistic goal? Leuk Res 2021; 103:106543. [PMID: 33640709 DOI: 10.1016/j.leukres.2021.106543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 12/14/2022]
Abstract
The introduction of hypomethylating agents (HMAs) 5-azacytidine and decitabine has altered the prognosis of patients with myelodysplastic syndrome (MDS). Over the past few years, the International Prognostic Scoring System (IPSS) and the revised IPSS (IPSS-R) have been used both to define the prognosis of patients with MDS and to select patients to be treated with HMAs. Nevertheless, the prognosis of individual patients with MDS can differ considerably from the one calculated with the use of the above-mentioned prognostic systems. Thus, some patients may achieve long-term survival irrespective of their initial prognostic score. Several factors besides those used to define the IPSS/IPSS-R are analyzed in this review article; these include age and gender, the baseline hematologic characteristics, the comorbidities, the cytogenetic and molecular profile of the patients, as well as their response to treatment with 5-azacytidine. Thus, insight into a more personalized way of managing patients with MDS is given and long-term survival is set as a more realistic goal of treatment with 5-azacytidine.
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Affiliation(s)
- Panagiotis T Diamantopoulos
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Nora-Athina Viniou
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Choi EJ, Lee JH, Park HS, Lee JH, Seol M, Lee YS, Kang YA, Jeon M, Woo JM, Lee KH. Decitabine Versus Intensive Chemotherapy for Elderly Patients With Newly Diagnosed Acute Myeloid Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:290-299.e3. [DOI: 10.1016/j.clml.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/29/2019] [Accepted: 02/11/2019] [Indexed: 12/17/2022]
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Bone marrow PARP1 mRNA levels predict response to treatment with 5-azacytidine in patients with myelodysplastic syndrome. Ann Hematol 2019; 98:1383-1392. [DOI: 10.1007/s00277-019-03650-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 03/02/2019] [Indexed: 01/13/2023]
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