Outcome of 5-Azacitidine and Decitabine Treatment in Elderly Patients with Myelodysplastic Syndrome

Myelodysplastic syndrome (MDS) are heterogenous group of hematologic disorders broadly characterized by cytopenias associated with a dysmorphic and usually cellular bone marrow, and by consequent ineffective blood cell production. For patients with MDS an epigenetic therapy with hypomethylating agents is considered standard of care. We evaluated the outcome of 5-Azacitidine and Decitabine treatment in elderly patients with myelodysplastic syndrome in our veterans hospital.

For analysis, patients were included if they were > 60 years, had morphological evidence of MDS per bone marrow examination at the time of diagnosis and were treated with either hypomethylating agent, 5-azacitidine and decitabine. The patients received 5-azacitidine 75mg/m2, d1–7 or decitabine 20mg/m2, d1–5 at four weeks interval. The primary end point was overall response rate.

A total of 25 patients were analyzed. Median age was 68 years (range 61–81 years). 9(36%) patients had received 5-azacitidine and 16(64%) patients had received decitabine. The International Prognostic Scoring System risk category was Intermediate-2/High in 44%. A median of 5 courses (range 1–16) were delivered and 60%(15/25) patients were treated 4 cycles over. The overall response rate was 59%. Patients who showed response (CR+PR+HI) had significantly longer overall survival than those who did not (30 months vs 5months, p=0. 01). With a median follow-up duration of 12 months, median overall survival was 14. 7 months. The difference in overall survival was evident in the Intermediate-2/High risk group but not in the Intermediate-1 risk group. However, the difference between 5-azacitidine and decitabine group was not stastically significant.

In our study, both 5-azacitidine and decitabine were feasible and effective in elderly patients with myelodysplastic syndrome. The overall survival was significantly longer in patients showing response. There were needed additional large-scale prospective studies.

No relevant conflicts of interest to declare.