PB1779 AZACITIDINE: DISCONTINUATION / RE‐TREATMENT; EXPERIENCE IN OUR CENTER
Authors: Cuenca Aprell C.A. , Iglesias‐Varela R. , Picallo‐Lombardía P. , Sastre‐Moral J.L. 
Published: June 2019

Background:

The incorporation at the beginning of the 21 st century of new hypomethylating treatments (such as Azacitidine and Decitabine) against AML and MDS has become a great change in patients who weren’t candidates for intensive chemotherapy.

The therapeutic aim in these patients is to develope transfusion independence, along with extrahospital follow‐up and reduction of complications derived from cytopenias.

Complete morphological / cytogenetic responses are achieved in a small percentage of patients which are, in general, of short duration.

The administration of Azacitidine, both in clinical trials and in daily practice, is usually administrated until the progression of the disease.

However, some situations can lead us to stop the treatment such as achieving complete remission, intolerance or the desire of the patient.

In case of a new progression of the disease, the possibility of resuming Azacitidine might be a valid option as it has been for some of our patients.

Aims:

We wanted to share the experience in our centre about re‐treatment with Azacitidine in patients who were not candidates to receive intensive chemotherapy

Methods:

We present a retrospective observational analysis of a total 158 patients who were treated with Azacitidine at University Hospital of Ourense from 2010 to 2018. They were diagnosed with SMD and/ or LMA. They were treated mostly with domiciliary administration of Azacitidine by a trained family member.

Treatment was discontinued in 13 people of these 158 patients for other reasons than progression / failure of response.

They have been analyzed by sex, cytogenetic risk, blastosis in bone marrow and peripheral blood, overall survival, survival since the beginning of treatment and survival since the beginning of the retreatment.

We classified patients by pathology (MDS or AML), by sex (5 women vs 8 men), by age

(an average age of 68.55 years) according to survival (alive vs dead) and by time of survival (from time of diagnosis, from the beginning of treatment, from time to relapse and since the beginning of restarting the treatment)

Results:

Thirteen patients treated with Azacitidine were discontinued, of which: three patients (23%) restarted Azacitidine but died; two patients (15%) recieved chemotherapy after Azacitidine and died; four patients (31%) after relapse of AML started chemotherapy and died; three patients (23%) restarted treatment with Azacititinde and are still alive; one patient (8%) has discontinued the treatment without progression (at this moment) and is still alive.

Patients who are still alive have an average survival of 96.25 months from diagnosis.

Summary/Conclusion:

In view of what was analyzed, the option of re‐treatment with Azacitidine might be an appropriate option in those patients who obtained an adequate response with Azacitidine in the past but they weren’t candidates for intensive chemotherapy.

The number of patients analyzed is not enough to draw conclusions statistically significant, but given the good experience that we have gotten, we will continue with this option in selected patients.