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Allogeneic hematopoietic stem cell transplant (allo-HSCT) is the only treatment with curative intent for patients with intermediate- or high-risk myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). However, treatment failure can occur due to relapse and graft-versus-host disease (GvHD). Decitabine is a pyrimidine analogue that inhibits cytosine methylation, resulting in activation of silent genes and thus has an anti-leukemic effect. Since recent studies have implicated epigenetic changes in the pathogenesis of MDS, the use of decitabine, in combination with standard conditioning regimens, may improve the outcome of patients who undergo allo-HSCT. To evaluate the role of decitabine in pre-allo-HSCT conditioning regimens, Qing Ya Wang, Yuan Li and colleagues, Peking University First Hospital, Beijing, CN, conducted a retrospective analysis in patients with intermediate- and high-risk MDS and transformed AML (tAML).
Given as dec vs non-dec
Given as dec vs non-dec
Given as dec vs non-dec
Patients in the dec group tended to be older and with higher risk disease, however a similar OS, DFS and RR was achieved. The authors suggest decitabine may, therefore, ameliorate the unfavorable characteristics of high-risk patients.
Including decitabine in the conditioning regimen prior to allo-HSCT in intermediate- and high-risk patients with MDS or AML decreased the incidence of Grade II–IV aGvHD and respiratory infections in this analysis. The authors hypothesize this is because decitabine exerts its effects via direct cytotoxicity and strengthened tumor immunity, whilst not compromising the GvHD protective effects.
A larger study would be required to confirm these results since the analysis and conclusions are limited by a small, retrospective sample of patients treated at one center, with differences in variables at baseline.
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