Clinical Research Papers:
Can we consider discontinuation of hypomethylating agents in patients with myelodysplastic syndrome : a retrospective study from The Korean Society of Hematology AML/MDS Working Party
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Da Jung Kim1, Ho Sup Lee1, Joon-Ho Moon2, Sang Kyun Sohn2, Hyeoung Joon Kim3, June-Won Cheong4, Deog-Yeon Jo5, Hawk Kim6, Hyewon Lee7, Soo-Mee Bang8, Won Sik Lee9, Yong Park10, Mark Hong Lee11, Jae Hoon Lee12, Sung Hwa Bae13, Min Kyoung Kim14 and The Korean Society of Hematology AML/MDS Working Party
1Department of Internal Medicine, Kosin University College of Medicine, Kosin University Gospel Hospital, Busan, South Korea
2Department of Hematology/Oncology, Kyungpook National University Hospital, Daegu, South Korea
3Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo, South Korea
4Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
5Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University, Daejeon, South Korea
6Division of Hematology and Cellular Therapy, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
7Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang, South Korea
8Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
9Department of Internal Medicine, Busan Paik Hospital, Busan, South Korea
10Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
11Division of Hematology-Oncology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
12Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
13Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, South Korea
14Department of Hematology-Oncology, Yeungnam University Medical Center, Yeungnam University School of Medicine, Daegu, South Korea
Ho Sup Lee, email: [email protected]
Keywords: myelodysplastic syndrome, discontinuation, survival, decitabine, azacitidine
Received: March 17, 2017 Accepted: April 28, 2017 Published: May 29, 2017
It is often difficult to continue treatment with hypomethylating agent(HMA) in clinical practice because of problems such as toxicities, poor economics, etc. We compared clinical outcomes of those patients who continued HMA and those who discontinued HMA because of other causes, and evaluated factors associated with survival in those patients who discontinued HMA.
Patients were divided into two groups: treatment failure, those who stopped treatment due to disease progression; and discontinuation, those who discontinued treatment because of other causes.
The median progression free survival(PFS) was 9.2 months (range 7.7 – 10.7 months) vs 28.9 months (range 22.6 – 35.2) in the treatment failure and discontinuation groups, respectively (P < 0.001). In a multivariate analysis, a lower risk by WPSS was an independent predictive factor for a longer PFS, and a lower risk by WPSS and median number of HMA cycles greater than seven were independent predictive factors for longer overall survival(OS) only in the discontinuation group.
Patients who discontinued HMA without disease progression showed a prolonged survival than those who failed HMA treatment. Especially, a lower risk by WPSS and longer duration of HMA treatment may be predictive factors for a longer PFS and OS in patients who discontinued HMA.
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