Decitabine can be safely reduced after achievement of best objective response in patients with myelodysplastic syndrome

Hady Ghanem, A. Megan Cornelison, Guillermo Garcia-Manero, Hagop Kantarjian, Farhad Ravandi, Tapan Kadia, Jorge Cortes, Susan O'Brien, Mark Brandt, Gautam Borthakur, Elias Jabbour

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Abstract

Background Decitabine is standard therapy in patients with myelodysplastic syndrome (MDS). Current recommendations suggest a dose of 20 mg/m2 intravenously (IV) daily for 5 days every 4 weeks. However, this therapy is associated with frequent grade 3/4 hematologic toxicity, requiring dose delays and/or dose reductions (DD/DR). Results We investigated the outcomes of 122 patients with MDS who had DD/DR of frontline decitabine therapy. Sixty-five patients (53%) had DR by at least 25% or DD (defined as a delay beyond 5 weeks between cycles). Thirty-five patients (29%) underwent DD/DR after achieving best objective response, 30 patients (25%) underwent DD/DR before best objective response, and 57 (54%) patients had no DD/DR. There was a trend for more durable responses in favor of patients requiring DD/DR after the achievement of best objective response (median not reached) (P =.161). Overall survival rates were significantly higher for patients who had DD/DR after best objective response compared with those who had DD/DR before best objective response or those with no DD/DR (30 vs. 22 vs. 11 months, respectively; P <.001). Progression-free survival (PFS) rates also trended higher for those with DD/DR after best objective response (median not reached) compared with those who required DD/DR before best objective response (median of 15 months) (P =.285). Conclusion DD/DR may be safely accomplished once the patient has achieved best objective response (preferably complete remission [CR]) without impacting outcome. Prospective evaluation of an approach conceived of a loading dose for induction of a best objective response followed by a maintenance schedule is to be considered.

Original languageEnglish (US)
Pages (from-to)S289-S294
JournalClinical Lymphoma, Myeloma and Leukemia
Volume13
Issue numberSUPPL. 2
DOIs
StatePublished - Sep 1 2013
Externally publishedYes

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Keywords

  • Decitabine
  • Dose delay
  • Dose reduction
  • Myelodysplastic syndrome

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Ghanem, H., Cornelison, A. M., Garcia-Manero, G., Kantarjian, H., Ravandi, F., Kadia, T., Cortes, J., O'Brien, S., Brandt, M., Borthakur, G., & Jabbour, E. (2013). Decitabine can be safely reduced after achievement of best objective response in patients with myelodysplastic syndrome. Clinical Lymphoma, Myeloma and Leukemia, 13(SUPPL. 2), S289-S294. https://doi.org/10.1016/j.clml.2013.05.025