Azacitidine in the Front-line Treatment of Therapy-related Myeloid Neoplasms: A Multicenter Case Series

Background/Aim: A continued increase in the incidence of therapy-related myeloid neoplasnis (t-MN) is expected due to the improvement of chemotherapeutic treatments for solid and haematological malignancies. The use of 5-azacytidine (AZA) is emerging in these patients. We, therefore, analyzed the outcome of patients with t-MN ineligible for intensive chemotherapy treated in the front-line with AZA. Patients and Methods: We retrospectively collected clinical data from consecutive patients with t-MN treated in the front-line with AZA at five Haematology Centers. Response to therapy, overall survival (OS) and safety were considered. Results: The overall response rate was of 35.7% with a median OS of 9.6 months. Patients who were heavily pre-treated for their primary malignancy (more than 3 lines of chemotherapy) presented a significant inferior OS (4.9 months). The principal reported toxicity was haematological with severe infections occurring in a minority of patients. Fatigue was the most common extra-haematological toxicity. Conclusion: New aspects emerged on the management of t-MN. AZA may represent a reasonable choice for patients ineligible for intensive treatment, with the exception of heavily pre-treated patients who presented -anyway- a worse outcome.