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      Treatment of acute myeloid leukemia or myelodysplastic syndrome relapse after allogeneic stem cell transplantation with azacitidine and donor lymphocyte infusions--a retrospective multicenter analysis from the German Cooperative Transplant Study Group.

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          Abstract

          To expand the current knowledge about azacitidine (Aza) and donor lymphocyte infusions (DLI) as salvage therapy for relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and to identify predictors for response and survival, we retrospectively analyzed data of 154 patients with acute myeloid leukemia (AML, n = 124), myelodysplastic (MDS, n = 28), or myeloproliferative syndrome (n = 2). All patients received a median number of 4 courses of Aza (range, 4 to 14) and DLI were administered to 105 patients (68%; median number of DLI, 2; range, 1 to 7). Complete and partial remission rates were 27% and 6%, respectively, resulting in an overall response rate of 33%. Multivariate analysis identified molecular-only relapse (hazard ratio [HR], 9.4; 95% confidence interval [CI], 2.0 to 43.5; P = .004) and diagnosis of MDS (HR, 4.1; 95% CI, 1.4 to 12.2; P = .011) as predictors for complete remission. Overall survival (OS) at 2 years was 29% ± 4%. Molecular-only relapse (HR, .14; 95% CI, .03 to .59; P = .007), diagnosis of MDS (HR, .33; 95% CI, .16 to .67; P = .002), and bone marrow blasts <13% (HR, .54; 95% CI, .32 to .91; P = .021) were associated with better OS. Accordingly, 2-year OS rate was higher in MDS patients (66% ± 10%, P = .001) and correlated with disease burden in patients with AML. In summary, Aza and DLI is an effective and well-tolerated treatment option for patients with relapse after allo-HSCT, in particular those with MDS or AML and low disease burden. The latter finding emphasizes the importance of stringent disease monitoring and early intervention.

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          Author and article information

          Journal
          Biol. Blood Marrow Transplant.
          Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
          Elsevier BV
          1523-6536
          1083-8791
          Apr 2015
          : 21
          : 4
          Affiliations
          [1 ] Department of Hematology, Oncology and Clinical Immunology, University of Duesseldorf, Medical Faculty, Duesseldorf, Germany. Electronic address: thomas.schroeder@med.uni-duesseldorf.de.
          [2 ] Department of Hematology, Oncology and Clinical Immunology, University of Duesseldorf, Medical Faculty, Duesseldorf, Germany.
          [3 ] Department of Medicine II, University Hospital, Frankfurt, Germany.
          [4 ] Department of Medicine A, Hematology and Oncology, University of Muenster, Muenster, Germany.
          [5 ] Universitätsmedizin Mannheim, Med. Klinik III, Mannheim, Germany.
          [6 ] Clinic for Bone Marrow Transplants, University Hospital Essen, Essen, Germany.
          [7 ] University Hospital Bonn, Med. Klinik III, Bonn, Germany.
          [8 ] Department of Medicine III, Karlsruhe Hospital, Karlsruhe, Germany.
          [9 ] Hannover Medical School, Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover, Germany.
          [10 ] University Hospital Carl Gustav Carus, Medical Clinic and Policlinic I, Dresden, Germany.
          [11 ] Charité Campus Benjamin Franklin, Medical Clinic Hematology, Oncology and Tumorimmunology, Berlin, Germany.
          [12 ] Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany.
          [13 ] University Hospital Hamburg-Eppendorf, Clinic for Stem Cell Transplantation, Hamburg, Germany.
          Article
          S1083-8791(14)01416-5
          10.1016/j.bbmt.2014.12.016
          25540937
          28e51e74-1fe8-4f72-a0ae-f0556e2371d6
          History

          Acute myeloid leukemia,Azacitidine,Donor lymphocyte infusions,Myelodysplastic syndromes,Relapse,Transplantation

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