Division of Hematology and Oncology, University of Freiburg Medical Center, Freiburg, Germany.
Bone Marrow Transplant. 2009 Nov;44(9):585-8. doi: 10.1038/bmt.2009.64. Epub 2009 Apr 13.
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.
目前正在开发新的、非强化治疗方案，用于计划进行同种异体移植的老年 MDS/AML 患者，目的是降低疾病分期并为移植争取时间。阿扎胞苷和地西他滨（DAC）特别引人注目，因为它们可以重复使用，具有非常有限的非血液学毒性，并且即使在低剂量下也能在 MDS 和 AML 中产生反应。我们描述了 15 例连续患者（中位年龄 69 岁，范围 60-75 岁），他们患有 MDS（n=10）或 AML（n=5），所有患者均接受 DAC 一线治疗，随后在 FBM 方案的低强度调理后进行同种异体移植（4 例来自同胞供体，11 例来自无关供体）。15 例患者中有 14 例成功植入，所有患者均获得完全缓解（CR），中位缓解持续时间为 5 个月（范围 1+至 51+）。这 14 例患者中有 6 例存活（4 例完全供体嵌合），8 例死亡，原因分别是复发（n=4）或在 CR 期间因治疗相关并发症（n=4）。我们得出结论，低剂量 DAC 后同种异体移植和随后用 FBM 调理是可行的，没有意外的毒性，并且似乎是老年 MDS/AML 患者标准化疗的有效替代方案（“InDACtion 而非诱导”）。
