Azacitidine Maintenance Demonstrates Lower Disease Progression Rate Among Patients With High-Risk FLT3-Negative AML/MDS

Azacitidine maintenance is associated with a lower progression rate in patients with high-risk FLT3-negative acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) and should be considered for maintenance after allogeneic hematopoietic stem cell transplantation for this group, according to a single center retrospective matched-control analysis.

Investigators examined the outcomes of 93 adult patients with FLT3-negative AML/MDS who received post-allogeneic hematopoietic stem cell transplantation (alloHSCT) azacitidine maintenance compared to 357 patients who received no maintenance therapy. The measured primary end point was disease progression.

It was noted that the azacitidine and control groups had comparable patient and disease characteristics except for older age (median: 61 vs 57 years, P = .01) and lower hematopoietic comorbidity index (median: 2 vs 3, P = .04) in the azacitidine group.

The 3-year cumulative incidence of progression in the azacitidine and control groups was 29% vs 33% (P = .09). Study authors further noted that a protective effect of azacitidine on progression was limited to patients with high-risk AML/MDS (hazard ratio [HR], 0.4; 95% confidence interval [CI], 0.2 to 0.8; P = .009). Improved progression-free survival (PFS) both in high-risk patients with AML and MDS with maintenance was observed (HR, 0.2; 95% CI, 0.1 to 0.6; P = .004 and HR,0.4; 95% CI,0.2 to 0.9; P = .04).

Oren Pasvolsky, MD, Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, and colleagues concluded, “[Azacitidine] maintenance was associated with a lower progression rate in patients with high-risk FLT3-negative AML or MDS, and [azacitidine] maintenance should be considered for post-alloHCT maintenance in this subset.”

Source:

Pasvolsky O, Saliba R, Popat U, et al. Azacitidine post-transplant maintenance improves disease progression in high-risk acute myeloid leukemia and myelodysplastic syndrome. Clin Lymph, Myel, & Leuk. Published online Feb 2, 2024. doi: 10.1016/j.clml.2024.01.012