Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Durable complete remission after single agent decitabine in AML relapsing in extramedullary sites after allo-SCT

Bone Marrow Transplantation volume 47, pages 1008–1009 (2012)Cite this article

Bolanos-Meade and colleagues have recently written about the potential use of 5-Azacytidine (5-Aza) without donor lymphocyte infusion in the treatment of 10 patients with myeloid malignancies relapsing after allogeneic BMT,1 and concluded that 5-Aza was an active agent and induced CR in 6 out of 10 patients. Despite the growing experience with 5-Aza in this setting,2, 3, 4, 5 there is little information on the use of the other hypomethylating drug, decitabine in the treatment of post-transplant relapsed AML. We report a successful treatment outcome in a 57-year-old male with primary refractory AML who relapsed in extramedullary sites after allo-SCT.

Immunosuppression was discontinued, but led to worsening oral mucosal lichenoid changes, painful ulcerations and elevation of liver function tests. He was treated with methylprednisolone 1 mg/kg per day and tacrolimus, resulting in rapid improvement in liver enzymes and oral GVHD. He was never given a donor lymphocyte infusion. Subsequently, he was initiated on decitabine at a dose of 20 mg/m2 i.v. daily for 5 days per monthly cycle and concurrently began to taper off his corticosteroid treatment. After the first cycle of decitabine, we observed a significant decrease in the size of his lymph nodes; and after the third cycle, he had no palpable lymph nodes detected on exam. He never had systemic relapse of AML during his follow-up. A PET-CT scan done after the fourth cycle of monthly decitabine therapy revealed complete resolution of the previously noted lesions (Figures 1b and 2b). His GVHD remained relatively inactive with tapering doses of corticosteroids. After eight cycles of monthly decitabine treatments, he was switched to a bi-monthly schedule because of delay in blood count recovery after subsequent cycles and he has received a total of 13 cycles of therapy with no serious side effects so far. He remains in CR with normal blood counts, and with mild oral and ocular chronic GVHD at 26 months after the extramedullary relapse (EMR) of AML.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

References

  1. Bolanos-Meade J, Smith BD, Gore SD, McDevitt MA, Luznik L, Fuchs EJ et al. 5-Azacytidine as salvage treatment in relapsed myeloid tumors after allogeneic bone marrow transplantation. Biol Blood and Marrow Transplant 2011; 17: 754–758.

    Article  CAS  Google Scholar 

  2. Issa JP, Garcia-Manero G, Giles FJ, Mannari R, Thomas D, Faderi S et al. Phase 1 study of low-dose prolonged exposure schedules of the hypomethylating agent 5-aza-2′-deoxycytidine (decitabine) in hematopoietic malignancies. Blood 2004; 103: 1635–1640.

    Article  CAS  PubMed  Google Scholar 

  3. Graef T, Kuendgen A, Fenk R, Zohren F, Haas R, Kobbe G . Successful treatment of relapsed AML after allogeneic stem cell transplantation with azacitidine. Leuk Res 2007; 31: 257–259.

    Article  CAS  PubMed  Google Scholar 

  4. Jabbour E, Giralt S, Kantarjian H, Garcia-Manero G, Jagasia M, Kebriaei P et al. Low-dose azacitidine after allogeneic stem cell transplantation for acute leukemia. Cancer 2009; 115: 1899–1905.

    Article  CAS  PubMed  Google Scholar 

  5. Guieze R, Jouinot A, Itzykson R, Thepot S, Guillaurne T, Coiteux V et al. Azacytidine (AZA) in relapsed MDS and AML after allogeneic stem cell transplantation (allo-HSCT): results of the French ATU Program. Blood 2010; 116 (ASH 2010 Annual Meeting Abstracts) 1293.

    Google Scholar 

  6. Koc Y, Miller KB, Schenkein DP, Daoust P, Sprague K, Berkman E . Extramedullary tumors of myeloid blasts in adults as a pattern of relapse following allogeneic bone marrow transplantation. Cancer 1999; 85: 608–615.

    Article  CAS  PubMed  Google Scholar 

  7. Clark WB, Strickland SA, Barrett AJ, Savani B . Extramedullary relapses after allogeneic stem cell transplantation for acute myeloid leukemia and myelodysplastic syndrome. Haematologica 2010; 95: 860–862.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kolb HJ . Graft-versus-leukemia effects of transplantation and donor lymphocytes. Blood 2008; 112: 4371–4383.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Maryland Medical Center, Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD, USA

    S N Singh, Q Cao, I Gojo, A P Rapoport & G Akpek

Authors
  1. S N Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Q Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I Gojo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A P Rapoport
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G Akpek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G Akpek.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Singh, S., Cao, Q., Gojo, I. et al. Durable complete remission after single agent decitabine in AML relapsing in extramedullary sites after allo-SCT. Bone Marrow Transplant 47, 1008–1009 (2012). https://doi.org/10.1038/bmt.2011.210

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2011.210

This article is cited by

Search

Advanced search

Quick links