Azacitidine and donor lymphocytes infusions in acute myeloid leukemia and myelodysplastic syndrome relapsed after allogeneic hematopoietic stem cell transplantation from alternative donors.

Azacitidine (AZA) either single-agent or with donor lymphocytes infusions (DLI) has been used as a salvage treatment for acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) relapsing after allogeneic hematopoietic stem cell transplantation (HSCT). To date, the majority of data come from patients relapsed after HSCT from full-matched donors. We report a multicenter, collaborative, retrospective analysis of 71 patients with hematologic ( Median time from HSCT to relapse was 9 months. Additional DLI were given to 33 patients (46%). After a median of four cycles, overall response rate (ORR) was 49% and complete response (CR) rate was 38%. CR lasted for a median of 17 months (range 5-89 months). Median follow-up in the entire cohort was 11 months (range 1-115 months). Event-free survival (EFS) and overall survival (OS) at 1 year were 26% and 53%, respectively. Treatment of molecular relapse granted higher CR rate (65% AZA ± DLI proved feasible and effective in AML and MDS relapsing after HSCT from alternative donors. Despite modest efficacy among hematologic relapses, pre-emptive treatment with AZA ± DLI fared better in molecular relapse. Additional DLI contributed to improving efficacy and ensuring longer survival.

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© The Author(s), 2022.

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Conflict of interest statement: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: S.F. received honoraria from Jazz Pharmaceuticals, served on advisory boards for Medac GmbH and Novartis. B.M. received honoraria from Celgene/BMS, Alexion, Novartis, MSD; travel grants from Celgene/MSD; served on advisory boards for BMS and Jazz Pharmaceuticals. C.M.G. declared consultancy for Janssen, Novartis, and Abbvie. S.T. declared research funding and consultancy for Celgene/BMS. R.C. received travel grants from Jazz Pharmaceuticals and Celgene/BMS; lecturing from Abbvie, Celgene/BMS, and Jazz Pharmaceuticals. MTLS has received travel grants from Neovii Biotech; honoraria from Incyte; served on advisory boards for Novartis and Mallinckrodt Pharmaceuticals. L.C., L.F., V.L., G.R., M.S., A.A., F.F., C.C., B.M., P.J., S.K., M.J.M., S.J., B.A., and C.F. declare no competing financial interests.