Comparison between 5-day decitabine and 7-day azacitidine for lower-risk myelodysplastic syndromes with poor prognostic features: a retrospective multicentre cohort study

Abstract

Numerous studies have analysed the clinical efficacies of hypomethylating agents (HMAs) in patients with myelodysplastic syndromes (MDS). However, reports that compare the two HMAs, decitabine and azacitidine, in patients with lower-risk (low and intermediate-1) MDS are limited. We compared 5-day decitabine and 7-day azacitidine regimens in terms of treatment responses, survival outcomes, and adverse events in patients with lower-risk MDS with poor prognostic features. The overall response rates (ORRs) were 67.2% and 44.0% in the patients treated with decitabine and azacitidine, respectively (P = 0.014). While the median progression-free survival (PFS) was significantly better in the patients treated with decitabine than in those treated with azacitidine (P = 0.019), no significant differences in event-free and overall survival rates were observed between the two groups. Multivariate analysis revealed that compared with azacitidine treatment, decitabine treatment is significantly associated with a higher ORR (P = 0.026) and longer PFS (P = 0.037). No significant differences were observed in the incidence of grade 3 or higher haematologic adverse events in response to the two HMAs. In conclusion, in lower-risk MDS, especially with poor prognostic features, ORR and PFS were significantly better with 5-day decitabine treatment than with 7-day azacitidine treatment, with comparable safety. Myelodysplastic syndromes (MDS) are clonal haematologic disorders characterised by ineffective and dysplastic haematopoiesis that causes cytopenia, leading to the development of acute leukaemia 1,2. Previously, MDS was generally divided into lower-risk (low and intermediate-1) and higher-risk (intermediate-2 and higher) categories on the basis of the International Prognostic Scoring System (IPSS) 3 , and treatment decisions were usually made based on the risk group. The treatment for higher-risk MDS aims to modify the natural course of the disease using hypomethylating agents (HMAs), chemotherapy, or stem cell transplantation, whereas the treatment for lower-risk MDS aims to improve cytopenia, reduce transfusion requirements, and provide the best supportive care 4. However, lower-risk MDS patients with poor prognostic features were known to be associated with progression to acute myeloid leukaemia or severe cytopenia 4. Hence, more active treatments are needed for this group of patients. Currently, two types of HMAs (decitabine or azacitidine) are available for the treatment of MDS 5. Several previous studies reported the efficacy of HMAs in different clinical settings. In higher-risk MDS, a 7-day azacitidine regimen (75 mg/m 2 daily every 4 weeks) was reported to result in higher response rates and better overall survival

Evaluation of Reduced-Dose Decitabine and Azacitidine for Treating Myelodysplastic Syndromes: A Retrospective Study

“…Our results are consistent with another study [ 30 ], which found a significant ORR improvement in the DAC regimen over the AZA regimen, and analyzed the prognostic response factors. The ANC was the only identified prognostic factor associated with the ORR to HMA.…”

Five‐day versus 7‐day treatment regimen with azacitidine in lower risk myelodysplastic syndrome: A phase 2, multicenter, randomized trial

“…There have been many other studies exploring the efficacies of AZA in LrMDS, and Table 5 summarizes the results of these studies 8–13,15–19,21,38,39 . For a 5‐day regimen, the reported HI and TI rates ranged from 38% to 50% and 33% to 60%, most of which were derived from prospective phase 2 trial 13,15–19 .…”

“…There have been many other studies exploring the efficacies of AZA in LrMDS, and Table 5 summarizes the results of these studies. [8][9][10][11][12][13][15][16][17][18][19]21,38,39 For a 5-day regimen, the reported HI and TI rates ranged from 38% to 50% and 33% to 60%, most of which were derived from prospective phase 2 trial. 13,[15][16][17][18][19] Real-world data from the US prospective registry, where approximately 75% of patients received 5-day regimen, showed higher rates of HI (70.8%) and TI (74.5%) in a subset of LrMDS patients.…”

The role of noncoding RNAs in metabolic reprogramming of cancer cells

“…Interestingly, a recent study demonstrated that the progression-free survival (PFS) of patients with MDS was significantly better in groups receiving decitabine than 5-azacytidine. Similarly, decitabine induced 67.2% overall response rates (ORRs), while 5-azacytidine showed 44% [ 169 ]. Another small molecule is enoxacin, which has antibacterial activities and could boost the expression of miRNAs by interacting with TARBP2, a miRNA biosynthesis protein [ 170 ].…”