Feasibility of allo-sct after hypomethylating therapy with decitabine for myelodysplastic syndrome

Feasibility of allo-sct after hypomethylating therapy with decitabine for myelodysplastic syndrome

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ABSTRACT Decitabine is a hypomethylating agent with activity in myelodysplastic syndrome (MDS). It is largely unknown whether treatment with this drug before allo-SCT will increase the toxicity of the preparative regimen or otherwise affect the results of the transplant. We report the outcome of 17 patients with MDS with a median age of 55.5 years (range, 36–66 years) who underwent an allo-SCT (12 siblings, 5 unrelated) after prior therapy with decitabine. Preparative regimens consisted of fludarabine in combination with BU (_n_=8) or melphalan (_n_=9). The source of stem cells was marrow in four patients and peripheral blood (PB) in 13 patients. Thirteen patients were in CR within 100 days of transplant. With a median follow-up of 12 months (range, 3–35 months), 11 patients are alive; eight in CR and three with progressive disease. Prior therapy with hypomethylating agents did not increase toxicity and may improve the outcome of allogeneic transplant in MDS and should be evaluated in a prospective trial. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your institution Subscribe to this journal Receive 12 print issues and online access $259.00 per year only $21.58 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS REDUCED INTENSITY VERSUS MYELOABLATIVE CONDITIONING FOR MDS: LONG-TERM RESULTS OF AN EBMT PHASE III STUDY (RICMAC) Article Open access 25 April 2024 THIOTEPA–FLUDARABINE–TREOSULFAN CONDITIONING FOR 2ND ALLOGENEIC HCT FROM AN ALTERNATIVE UNRELATED DONOR FOR PATIENTS WITH AML: A PROSPECTIVE MULTICENTER PHASE II TRIAL Article Open access 18 August 2022 ORAL DECITABINE CEDAZURIDINE WITH AND WITHOUT VENETOCLAX IN HIGHER-RISK MYELODYSPLASTIC SYNDROMES OR CHRONIC MYELOMONOCYTIC LEUKEMIA: A PROPENSITY SCORE–MATCHED STUDY Article Open access 31 March 2025 REFERENCES * Schiffer CA . Clinical issues in the management of patients with myelodysplasia. In: Gerwitz AM, Winter JN, Zuckerman K (eds). _Hematology, Am Soc Hematol Educ Program_, 2006, pp 205–210. Article  Google Scholar  * Silverman LR, Demakos EP, Peterson BL, Kornblith AB, Holland JC, Odchimar-Reissig R _et al_. Randomized controlled trial of azacitidine in patients with the myelodysplastic syndrome: a study of the cancer and leukemia group B. _J Clin Oncol_ 2002; 20: 2429–2440. Article  CAS  Google Scholar  * Kantarjian H, Issa JP, Rosenfeld CS, Bennett JM, Albitar M, DiPersio J _et al_. Decitabine improves patient outcomes in myelodysplastic syndromes: results of a phase III randomized study. _Cancer_ 2006; 106: 1794–1803. Article  CAS  Google Scholar  * List A, Dewald G, Bennett J, Giagounidis A, Raza A, Feldman E _et al_. Lenalidomide in the myelodysplastic syndrome with chromosome 5q deletion. _N Engl J Med_ 2006; 355: 1456–1465. Article  CAS  Google Scholar  * Herman JG, Baylin SB . Gene silencing in cancer in association with promoter hypermethylation. _N Engl J Med_ 2003; 349: 2042–2054. Article  CAS  Google Scholar  * Issa JP . CpG island methylator phenotype in cancer. _Nat Rev Cancer_ 2004; 4: 988–993. Article  CAS  Google Scholar  * Issa JP . Optimizing therapy with methylation inhibitors in myelodysplastic syndromes:dose, duration, and patient selection. _Nat Clin Pract Oncol_ 2005; 2: 24–29. Article  Google Scholar  * Toyota M, Kopecky KJ, Toyota MO, Jair KW, Willman CL, Issa JP . Methylation profiling in acute myeloid leukemia. _Blood_ 2001; 97: 2823–2829. Article  CAS  Google Scholar  * Pinto A, Zagonel V . 5-Aza-2′-deoxycytidine (Decitabine) and 5-azacytidine in the treatment of acute myeloid leukemias and myelodysplastic syndromes: past, present and future trends. _Leukemia_ 1993; 7: 51–60. PubMed  Google Scholar  * Pinto A, Maio M, Attadia V, Zappacosta S, Cimino R . Modulation of HLA-DR antigens expression in human myeloid leukaemia cells by cytarabine and 5-aza-2′-deoxycytidine. _Lancet_ 1984; 2: 867–868. Article  CAS  Google Scholar  * Pinto A, Zagonel V, Attadia V, Bullian PL, Gattei V, Carbone A _et al_. 5-Aza-2′-deoxycytidine as a differentiation inducer in acute myeloid leukaemias and myelodysplastic syndromes of the elderly. _Bone Marrow Transplant_ 1989; 4: 28–32. PubMed  Google Scholar  * Kantarjian H, Oki Y, Garcia-Manero G, Huang X, O'Brien S, Cortes J _et al_. Results of a randomized study of 3 schedules of low-dose decitabine in higher-risk myelodysplastic syndrome and chronic myelomonocytic leukemia. _Blood_ 2007; 109: 52–57. Article  CAS  Google Scholar  * Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Atein H _et al_. (eds). _World Health Organization Classification of Tumors of Haematopoietic and Lymphoid Tissues_, 4th edn. International Agency for Research on Cancer (IARC), 2008, 439pp. Google Scholar  * Cutler CS, Lee SJ, Greenberg P, Deeg HJ, Perez WS, Anasetti C _et al_. A decision analysis of allogeneic bone marrow transplantation for the myelodysplasia syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome. _Blood_ 2004; 104: 579–585. Article  CAS  Google Scholar  * Ambs A, Warren JL, Bellizzi KM, Topor M, Haffer SC, Clauser SB . Overview of the SEER—medicare health outcomes survey linked dataset. _Health Care Financ Rev_ 2008 Summer; 29: 5–21. PubMed  PubMed Central  Google Scholar  * de Witte T, Hermans J, Vossen J, Bacigalupo A, Meloni G, Jacobsen N _et al_. Haematopoietic stem cell transplantation for patients with myelo-dysplastic syndromes and secondary acute myeloid leukemias: a report on behalf of the Chronic Leukaemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT). _Br J Haematol_ 2000; 110: 620–630. Article  CAS  Google Scholar  * Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG _et al_. Hematopoietic cell transplantation (HCT)-specific comorbidities index: a new tool for risk assessment before allogeneic HCT. _Blood_ 2005; 106: 2912–2919. Article  CAS  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Stem Cell Transplantation and Cell Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA L De Padua Silva, M de Lima, P Kebriaei, S Giralt & R Champlin * Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA L De Padua Silva, H Kantarjian, S Faderl, J Davisson, G Garcia-Manero, J-P Issa & F Ravandi Authors * L De Padua Silva View author publications You can also search for this author inPubMed Google Scholar * M de Lima View author publications You can also search for this author inPubMed Google Scholar * H Kantarjian View author publications You can also search for this author inPubMed Google Scholar * S Faderl View author publications You can also search for this author inPubMed Google Scholar * P Kebriaei View author publications You can also search for this author inPubMed Google Scholar * S Giralt View author publications You can also search for this author inPubMed Google Scholar * J Davisson View author publications You can also search for this author inPubMed Google Scholar * G Garcia-Manero View author publications You can also search for this author inPubMed Google Scholar * R Champlin View author publications You can also search for this author inPubMed Google Scholar * J-P Issa View author publications You can also search for this author inPubMed Google Scholar * F Ravandi View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to M de Lima. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE De Padua Silva, L., de Lima, M., Kantarjian, H. _et al._ Feasibility of allo-SCT after hypomethylating therapy with decitabine for myelodysplastic syndrome. _Bone Marrow Transplant_ 43, 839–843 (2009). https://doi.org/10.1038/bmt.2008.400 Download citation * Received: 08 July 2008 * Revised: 15 October 2008 * Accepted: 17 October 2008 * Published: 19 January 2009 * Issue Date: June 2009 * DOI: https://doi.org/10.1038/bmt.2008.400 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative KEYWORDS * myelodysplastic syndrome * decitabine * allo-SCT

ABSTRACT Decitabine is a hypomethylating agent with activity in myelodysplastic syndrome (MDS). It is largely unknown whether treatment with this drug before allo-SCT will increase the


toxicity of the preparative regimen or otherwise affect the results of the transplant. We report the outcome of 17 patients with MDS with a median age of 55.5 years (range, 36–66 years) who


underwent an allo-SCT (12 siblings, 5 unrelated) after prior therapy with decitabine. Preparative regimens consisted of fludarabine in combination with BU (_n_=8) or melphalan (_n_=9). The


source of stem cells was marrow in four patients and peripheral blood (PB) in 13 patients. Thirteen patients were in CR within 100 days of transplant. With a median follow-up of 12 months


(range, 3–35 months), 11 patients are alive; eight in CR and three with progressive disease. Prior therapy with hypomethylating agents did not increase toxicity and may improve the outcome


of allogeneic transplant in MDS and should be evaluated in a prospective trial. Access through your institution Buy or subscribe This is a preview of subscription content, access via your


institution ACCESS OPTIONS Access through your institution Subscribe to this journal Receive 12 print issues and online access $259.00 per year only $21.58 per issue Learn more Buy this


article * Purchase on SpringerLink * Instant access to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in


* Learn about institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS REDUCED INTENSITY VERSUS MYELOABLATIVE CONDITIONING FOR MDS:


LONG-TERM RESULTS OF AN EBMT PHASE III STUDY (RICMAC) Article Open access 25 April 2024 THIOTEPA–FLUDARABINE–TREOSULFAN CONDITIONING FOR 2ND ALLOGENEIC HCT FROM AN ALTERNATIVE UNRELATED


DONOR FOR PATIENTS WITH AML: A PROSPECTIVE MULTICENTER PHASE II TRIAL Article Open access 18 August 2022 ORAL DECITABINE CEDAZURIDINE WITH AND WITHOUT VENETOCLAX IN HIGHER-RISK


MYELODYSPLASTIC SYNDROMES OR CHRONIC MYELOMONOCYTIC LEUKEMIA: A PROPENSITY SCORE–MATCHED STUDY Article Open access 31 March 2025 REFERENCES * Schiffer CA . Clinical issues in the management


of patients with myelodysplasia. In: Gerwitz AM, Winter JN, Zuckerman K (eds). _Hematology, Am Soc Hematol Educ Program_, 2006, pp 205–210. Article  Google Scholar  * Silverman LR, Demakos


EP, Peterson BL, Kornblith AB, Holland JC, Odchimar-Reissig R _et al_. Randomized controlled trial of azacitidine in patients with the myelodysplastic syndrome: a study of the cancer and


leukemia group B. _J Clin Oncol_ 2002; 20: 2429–2440. Article  CAS  Google Scholar  * Kantarjian H, Issa JP, Rosenfeld CS, Bennett JM, Albitar M, DiPersio J _et al_. Decitabine improves


patient outcomes in myelodysplastic syndromes: results of a phase III randomized study. _Cancer_ 2006; 106: 1794–1803. Article  CAS  Google Scholar  * List A, Dewald G, Bennett J,


Giagounidis A, Raza A, Feldman E _et al_. Lenalidomide in the myelodysplastic syndrome with chromosome 5q deletion. _N Engl J Med_ 2006; 355: 1456–1465. Article  CAS  Google Scholar  *


Herman JG, Baylin SB . Gene silencing in cancer in association with promoter hypermethylation. _N Engl J Med_ 2003; 349: 2042–2054. Article  CAS  Google Scholar  * Issa JP . CpG island


methylator phenotype in cancer. _Nat Rev Cancer_ 2004; 4: 988–993. Article  CAS  Google Scholar  * Issa JP . Optimizing therapy with methylation inhibitors in myelodysplastic syndromes:dose,


duration, and patient selection. _Nat Clin Pract Oncol_ 2005; 2: 24–29. Article  Google Scholar  * Toyota M, Kopecky KJ, Toyota MO, Jair KW, Willman CL, Issa JP . Methylation profiling in


acute myeloid leukemia. _Blood_ 2001; 97: 2823–2829. Article  CAS  Google Scholar  * Pinto A, Zagonel V . 5-Aza-2′-deoxycytidine (Decitabine) and 5-azacytidine in the treatment of acute


myeloid leukemias and myelodysplastic syndromes: past, present and future trends. _Leukemia_ 1993; 7: 51–60. PubMed  Google Scholar  * Pinto A, Maio M, Attadia V, Zappacosta S, Cimino R .


Modulation of HLA-DR antigens expression in human myeloid leukaemia cells by cytarabine and 5-aza-2′-deoxycytidine. _Lancet_ 1984; 2: 867–868. Article  CAS  Google Scholar  * Pinto A,


Zagonel V, Attadia V, Bullian PL, Gattei V, Carbone A _et al_. 5-Aza-2′-deoxycytidine as a differentiation inducer in acute myeloid leukaemias and myelodysplastic syndromes of the elderly.


_Bone Marrow Transplant_ 1989; 4: 28–32. PubMed  Google Scholar  * Kantarjian H, Oki Y, Garcia-Manero G, Huang X, O'Brien S, Cortes J _et al_. Results of a randomized study of 3


schedules of low-dose decitabine in higher-risk myelodysplastic syndrome and chronic myelomonocytic leukemia. _Blood_ 2007; 109: 52–57. Article  CAS  Google Scholar  * Swerdlow SH, Campo E,


Harris NL, Jaffe ES, Pileri SA, Atein H _et al_. (eds). _World Health Organization Classification of Tumors of Haematopoietic and Lymphoid Tissues_, 4th edn. International Agency for


Research on Cancer (IARC), 2008, 439pp. Google Scholar  * Cutler CS, Lee SJ, Greenberg P, Deeg HJ, Perez WS, Anasetti C _et al_. A decision analysis of allogeneic bone marrow transplantation


for the myelodysplasia syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome. _Blood_ 2004; 104: 579–585. Article  CAS  Google Scholar  * Ambs


A, Warren JL, Bellizzi KM, Topor M, Haffer SC, Clauser SB . Overview of the SEER—medicare health outcomes survey linked dataset. _Health Care Financ Rev_ 2008 Summer; 29: 5–21. PubMed 


PubMed Central  Google Scholar  * de Witte T, Hermans J, Vossen J, Bacigalupo A, Meloni G, Jacobsen N _et al_. Haematopoietic stem cell transplantation for patients with myelo-dysplastic


syndromes and secondary acute myeloid leukemias: a report on behalf of the Chronic Leukaemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT). _Br J Haematol_


2000; 110: 620–630. Article  CAS  Google Scholar  * Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG _et al_. Hematopoietic cell transplantation (HCT)-specific comorbidities


index: a new tool for risk assessment before allogeneic HCT. _Blood_ 2005; 106: 2912–2919. Article  CAS  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS *


Department of Stem Cell Transplantation and Cell Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA L De Padua Silva, M de Lima, P Kebriaei, S Giralt & R


Champlin * Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA L De Padua Silva, H Kantarjian, S Faderl, J Davisson, G Garcia-Manero, J-P Issa & F


Ravandi Authors * L De Padua Silva View author publications You can also search for this author inPubMed Google Scholar * M de Lima View author publications You can also search for this


author inPubMed Google Scholar * H Kantarjian View author publications You can also search for this author inPubMed Google Scholar * S Faderl View author publications You can also search for


this author inPubMed Google Scholar * P Kebriaei View author publications You can also search for this author inPubMed Google Scholar * S Giralt View author publications You can also search


for this author inPubMed Google Scholar * J Davisson View author publications You can also search for this author inPubMed Google Scholar * G Garcia-Manero View author publications You can


also search for this author inPubMed Google Scholar * R Champlin View author publications You can also search for this author inPubMed Google Scholar * J-P Issa View author publications You


can also search for this author inPubMed Google Scholar * F Ravandi View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence


to M de Lima. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE De Padua Silva, L., de Lima, M., Kantarjian, H. _et al._ Feasibility of allo-SCT after


hypomethylating therapy with decitabine for myelodysplastic syndrome. _Bone Marrow Transplant_ 43, 839–843 (2009). https://doi.org/10.1038/bmt.2008.400 Download citation * Received: 08 July


2008 * Revised: 15 October 2008 * Accepted: 17 October 2008 * Published: 19 January 2009 * Issue Date: June 2009 * DOI: https://doi.org/10.1038/bmt.2008.400 SHARE THIS ARTICLE Anyone you


share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the


Springer Nature SharedIt content-sharing initiative KEYWORDS * myelodysplastic syndrome * decitabine * allo-SCT