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Azacytidine treatment after discontinuation of immunosuppressants in patients with myelodysplastic syndrome and relapse after allo-SCT at a single center

Bone Marrow Transplantation volume 45, pages 1375–1376 (2010)Cite this article

Although newly developed drugs are available for myelodysplastic syndrome (MDS), the only reliable curative treatment strategy for MDS is an allo-SCT. However, the therapeutic options for patients who relapse after transplantation are limited.1 Attempts to maximize the GVL effects by donor lymphocyte infusion have been generally unsuccessful for restoration of a CR.2 Trials of donor lymphocyte infusion in combination with chemotherapy have shown increased response rates, but the long-term survival of relapsed patients is low.3 Some explanations for the unsatisfactory outcome are treatment-related mortality caused by regimen-related toxicity, life-threatening GVHD and the associated infections. Hypomethylating agents have an advantage over conventional cytotoxic chemotherapeutic agents in terms of regimen-related toxicity and OS in high-risk MDS patients.4 With regard to transplantation, recent studies have suggested that hypomethylating agents may potentiate GVL effects.5, 6, 7, 8 Therefore, a pilot study of azacytidine treatment after discontinuation of immunosuppressants was performed in MDS patients who relapsed after transplantation.

All study patients underwent PBSCT with a fludarabine-based conditioning regimen. The interval from transplantation to relapse ranged from 3.6 to 23.1 months. All patients discontinued immunosuppressants when a relapse was diagnosed. After discontinuation of the immunosuppressants, we treated four patients with four cycles of azacytidine (75 mg/m2 for 7 consecutive days) at 4- to 5-week intervals. Responses were evaluated after each cycle of azacytidine using the criteria of the international working group.9 Toxicity was evaluated using the toxicity criteria version 2.0 of the National Cancer Institute.

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Authors and Affiliations

  1. Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea

    S-Y Kim, S-G Cho, B-S Cho, M-S Kim, K-S Eom, Y-J Kim, H-J Kim, S Lee, C-K Min, D-W Kim, J-W Lee & W-S Min

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  1. S-Y Kim
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Correspondence to S-G Cho.

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Kim, SY., Cho, SG., Cho, BS. et al. Azacytidine treatment after discontinuation of immunosuppressants in patients with myelodysplastic syndrome and relapse after allo-SCT at a single center. Bone Marrow Transplant 45, 1375–1376 (2010). https://doi.org/10.1038/bmt.2009.355

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