Prospective phase II study on 5-days azacitidine for treatment of symptomatic and/or erythropoietin unresponsive patients with low/INT-1-risk myelodysplastic syndromes

Carla Filì, Michele Malagola, Matilde Y. Follo, Carlo Finelli, Ilaria Iacobucci, Giovanni Martinelli, Federica Cattina, Cristina Clissa, Anna Candoni, Renato Fanin, Marco Gobbi, Monica Bocchia, Marzia Defina, Pierangelo Spedini, Cristina Skert, Lucia Manzoli, Lucio Cocco, Domenico Russo

Research output: Contribution to journalArticle

Abstract

Purpose: This phase II prospective study aimed to evaluate the efficacy and safety of 5-days azacytidine (5d-AZA) in patients with low-risk myelodysplastic syndromes (MDS). Second, single-nucleotide polymorphism (SNP) genetic profile and phosphoinositide-phospholipase C (PI-PLC) β1 levels were studied to evaluate possible biologic markers able to predict the hematologic response. Experimental Design: The study tested a lower intensity schedule of azacytidine. The treatment plan consisted of 75 mg/sqm/d subcutaneous administered for 5 days every 28 days, for a total of 8 cycles. Results: Thirty-two patients were enrolled in the study. The overall response rate was 47% (15 of 32) on intention-to-treat and 58% (15 of 26) for patients completing the treatment program. In this latter group, 5 (19%) achieved complete remission (CR) and 10 (38%) had hematologic improvement, according to the International Working Group (IWG) criteria. Three patients have maintained their hematologic improvement after 37, 34, and 33 months without other treatments. Moreover, 21 and 2 of 26 cases completing 8 cycles were transfusion-dependent for red blood cells and platelets at baseline, respectively. Of these, 7 (33%) and 2 (100%) became transfusion-independent at the end of the treatment program, respectively. Grade 3-4 neutropenia occurred in 28% of patients and 4 patients died early due to infections or hemorrhage. SNP results were not significantly correlated to the clinical outcome, whereas PI-PLCβ1 level anticipated either positive or negative clinical responses. Conclusions: 5d-AZA is safe and effective in a proportion of patients with low-risk MDS. PI-PLCβ1 gene expression is a reliable and dynamic marker of response that can be useful to optimize azacytidine therapy.

Original languageEnglish
Pages (from-to)3297-3308
Number of pages12
JournalClinical Cancer Research
Volume19
Issue number12
DOIs
Publication statusPublished - Jun 15 2013

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Azacitidine
Myelodysplastic Syndromes
Erythropoietin
Therapeutics
Single Nucleotide Polymorphism
Phosphoinositide Phospholipase C
iodonitrotetrazolium
Neutropenia
Appointments and Schedules
Research Design
Blood Platelets
Biomarkers
Prospective Studies
Hemorrhage
Safety
Gene Expression
Infection

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Prospective phase II study on 5-days azacitidine for treatment of symptomatic and/or erythropoietin unresponsive patients with low/INT-1-risk myelodysplastic syndromes. / Filì, Carla; Malagola, Michele; Follo, Matilde Y.; Finelli, Carlo; Iacobucci, Ilaria; Martinelli, Giovanni; Cattina, Federica; Clissa, Cristina; Candoni, Anna; Fanin, Renato; Gobbi, Marco; Bocchia, Monica; Defina, Marzia; Spedini, Pierangelo; Skert, Cristina; Manzoli, Lucia; Cocco, Lucio; Russo, Domenico.

In: Clinical Cancer Research, Vol. 19, No. 12, 15.06.2013, p. 3297-3308.

Research output: Contribution to journalArticle

Filì, C, Malagola, M, Follo, MY, Finelli, C, Iacobucci, I, Martinelli, G, Cattina, F, Clissa, C, Candoni, A, Fanin, R, Gobbi, M, Bocchia, M, Defina, M, Spedini, P, Skert, C, Manzoli, L, Cocco, L & Russo, D 2013, 'Prospective phase II study on 5-days azacitidine for treatment of symptomatic and/or erythropoietin unresponsive patients with low/INT-1-risk myelodysplastic syndromes', Clinical Cancer Research, vol. 19, no. 12, pp. 3297-3308. https://doi.org/10.1158/1078-0432.CCR-12-3540
Filì, Carla ; Malagola, Michele ; Follo, Matilde Y. ; Finelli, Carlo ; Iacobucci, Ilaria ; Martinelli, Giovanni ; Cattina, Federica ; Clissa, Cristina ; Candoni, Anna ; Fanin, Renato ; Gobbi, Marco ; Bocchia, Monica ; Defina, Marzia ; Spedini, Pierangelo ; Skert, Cristina ; Manzoli, Lucia ; Cocco, Lucio ; Russo, Domenico. / Prospective phase II study on 5-days azacitidine for treatment of symptomatic and/or erythropoietin unresponsive patients with low/INT-1-risk myelodysplastic syndromes. In: Clinical Cancer Research. 2013 ; Vol. 19, No. 12. pp. 3297-3308.
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abstract = "Purpose: This phase II prospective study aimed to evaluate the efficacy and safety of 5-days azacytidine (5d-AZA) in patients with low-risk myelodysplastic syndromes (MDS). Second, single-nucleotide polymorphism (SNP) genetic profile and phosphoinositide-phospholipase C (PI-PLC) β1 levels were studied to evaluate possible biologic markers able to predict the hematologic response. Experimental Design: The study tested a lower intensity schedule of azacytidine. The treatment plan consisted of 75 mg/sqm/d subcutaneous administered for 5 days every 28 days, for a total of 8 cycles. Results: Thirty-two patients were enrolled in the study. The overall response rate was 47{\%} (15 of 32) on intention-to-treat and 58{\%} (15 of 26) for patients completing the treatment program. In this latter group, 5 (19{\%}) achieved complete remission (CR) and 10 (38{\%}) had hematologic improvement, according to the International Working Group (IWG) criteria. Three patients have maintained their hematologic improvement after 37, 34, and 33 months without other treatments. Moreover, 21 and 2 of 26 cases completing 8 cycles were transfusion-dependent for red blood cells and platelets at baseline, respectively. Of these, 7 (33{\%}) and 2 (100{\%}) became transfusion-independent at the end of the treatment program, respectively. Grade 3-4 neutropenia occurred in 28{\%} of patients and 4 patients died early due to infections or hemorrhage. SNP results were not significantly correlated to the clinical outcome, whereas PI-PLCβ1 level anticipated either positive or negative clinical responses. Conclusions: 5d-AZA is safe and effective in a proportion of patients with low-risk MDS. PI-PLCβ1 gene expression is a reliable and dynamic marker of response that can be useful to optimize azacytidine therapy.",
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T1 - Prospective phase II study on 5-days azacitidine for treatment of symptomatic and/or erythropoietin unresponsive patients with low/INT-1-risk myelodysplastic syndromes

AU - Filì, Carla

AU - Malagola, Michele

AU - Follo, Matilde Y.

AU - Finelli, Carlo

AU - Iacobucci, Ilaria

AU - Martinelli, Giovanni

AU - Cattina, Federica

AU - Clissa, Cristina

AU - Candoni, Anna

AU - Fanin, Renato

AU - Gobbi, Marco

AU - Bocchia, Monica

AU - Defina, Marzia

AU - Spedini, Pierangelo

AU - Skert, Cristina

AU - Manzoli, Lucia

AU - Cocco, Lucio

AU - Russo, Domenico

PY - 2013/6/15

Y1 - 2013/6/15

N2 - Purpose: This phase II prospective study aimed to evaluate the efficacy and safety of 5-days azacytidine (5d-AZA) in patients with low-risk myelodysplastic syndromes (MDS). Second, single-nucleotide polymorphism (SNP) genetic profile and phosphoinositide-phospholipase C (PI-PLC) β1 levels were studied to evaluate possible biologic markers able to predict the hematologic response. Experimental Design: The study tested a lower intensity schedule of azacytidine. The treatment plan consisted of 75 mg/sqm/d subcutaneous administered for 5 days every 28 days, for a total of 8 cycles. Results: Thirty-two patients were enrolled in the study. The overall response rate was 47% (15 of 32) on intention-to-treat and 58% (15 of 26) for patients completing the treatment program. In this latter group, 5 (19%) achieved complete remission (CR) and 10 (38%) had hematologic improvement, according to the International Working Group (IWG) criteria. Three patients have maintained their hematologic improvement after 37, 34, and 33 months without other treatments. Moreover, 21 and 2 of 26 cases completing 8 cycles were transfusion-dependent for red blood cells and platelets at baseline, respectively. Of these, 7 (33%) and 2 (100%) became transfusion-independent at the end of the treatment program, respectively. Grade 3-4 neutropenia occurred in 28% of patients and 4 patients died early due to infections or hemorrhage. SNP results were not significantly correlated to the clinical outcome, whereas PI-PLCβ1 level anticipated either positive or negative clinical responses. Conclusions: 5d-AZA is safe and effective in a proportion of patients with low-risk MDS. PI-PLCβ1 gene expression is a reliable and dynamic marker of response that can be useful to optimize azacytidine therapy.

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