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Allografting

Non-intensive treatment with low-dose 5-aza-2′-deoxycytidine (DAC) prior to allogeneic blood SCT of older MDS/AML patients

Bone Marrow Transplantation volume 44, pages 585–588 (2009)Cite this article

Abstract

Novel, non-intensive treatment options in older MDS/AML patients planned for allografting, with the goal of down-staging the underlying disease and bridging time to transplantation, are presently being developed. 5-azacytidine and decitabine (DAC) are of particular interest, as they can be given repetitively, with very limited non-hematologic toxicity and result in responses both in MDS and AML even at low doses. We describe 15 consecutive patients (median age 69 years, range 60–75 years) with MDS (n=10) or AML (n=5) who all received first-line treatment with DAC and subsequent allografting (from sibling donor in four patients, unrelated donor in 11) after reduced-intensity conditioning with the FBM regimen. Successful engraftment was attained in 14/15 patients, all of whom achieved a CR, with a median duration of 5 months (range 1+ to 51+). Six of these 14 patients are alive (4 with complete donor chimerism), 8 have died either from relapse (n=4) or treatment-related complications while in CR (n=4). We conclude that allografting after low-dose DAC and subsequent conditioning with FBM is feasible, with no unexpected toxicities and appears as a valid alternative to standard chemotherapy (‘InDACtion instead of induction’) in elderly patients with MDS/AML.

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Acknowledgements

We thank Roland Mertelsmann, Freiburg and Pierre Wijermans, The Hague, for continued helpful discussions and support of this study, and Sebastian Fetscher, Lübeck, for coining the term ‘inDACtion’.

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Author notes

  1. B Rüter

    Present address: 2Current address: Merck Darmstadt, Darmstadt, Germany,

  2. R Claus

    Present address: 3Current address: Department of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), Heidelberg, Germany,

  3. R Claus: Research Fellowship Program at the Division of Hematology and Oncology

Authors and Affiliations

  1. Division of Hematology and Oncology, University of Freiburg Medical Center, Freiburg, Germany

    M Lübbert, H Bertz, B Rüter, R Marks, R Claus, R Wäsch & J Finke

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  1. M Lübbert
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  2. H Bertz
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  7. J Finke
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Correspondence to M Lübbert or J Finke.

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Lübbert, M., Bertz, H., Rüter, B. et al. Non-intensive treatment with low-dose 5-aza-2′-deoxycytidine (DAC) prior to allogeneic blood SCT of older MDS/AML patients. Bone Marrow Transplant 44, 585–588 (2009). https://doi.org/10.1038/bmt.2009.64

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