Azacytidine treatment after discontinuation of immunosuppressants in patients with myelodysplastic syndrome and relapse after allo-SCT at a single center.

摘要

Although newly developed drugs are available for myelo-dysplastic syndrome (MDS), the only reliable curative treatment strategy for MDS is an allo-SCT. However, the therapeutic options for patients who relapse after transplantation are limited. Attempts to maximize the GVL effects by donor lymphocyte infusion have been generally unsuccessful for restoration of a CR. Trials of donor lymphocyte infusion in combination with chemotherapy have shown increased response rates, but the long-term survival of relapsed patients is low. Some explanations for the unsatisfactory outcome are treatment-related mortality caused by regimen-related toxicity, life-threatening GVHD and the associated infections. Hypomethylating agents have an advantage over conventional cytotoxic chemothera-peutic agents in terms of regimen-related toxicity and OS in high-risk MDS patients. With regard to transplantation, recent studies have suggested that hypomethylating agents may potentiate GVL effects. Therefore, a pilot study of azacytidine treatment after discontinuation of immuno-suppressants was performed in MDS patients who relapsed after transplantation.