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P-175 Elderly patient with acute myeloid leukemia refractory to decitabine who responded to treatment with azacitidine
S102
Poster Presentations – 12th International Symposium on Myelodysplastic Syndromes / Leukemia Research 37 S1 (2013) S1–S117
confirmed and a biopsy confirmed the presence of an aspergilloma in left maxillary sinus. Regarding its AML with azacitidine scheme, after the third cycle was achieved complete response and so far she has received 12 cycles with this drug well tolerated with no evidence of relapse of hematologic malignancy. At this time, the patient is in good general condition, with adequate quality of life, well tolerated chemotherapy and in treatment of invasive aspergillosis with voriconazole. Conclusions: The treatment with hypomethylating agents has become an option for patients with AML who are not candidates for intensive chemotherapy. These data suggest that it is feasible to use a hypomethylating agent when patients are refractory to other drug of the same class.
Figure 1. Graph of important laboratory parameters which have been related to key stages in the course of the disease.
condition and reversal of coagulopathy with azacitidine strongly suggested that DIC was secondary to MDS. Azacitidine has shown a significantly higher response in patients with monosomy 7 and we postulate that this might have led to reversal of DIC. We suggest a DIC screen should be undertaken in all MDS patients presenting with bleeding symptoms. Clinicians should also be aware of drowsiness as a rare side effect of azacitidine.
P-175 Elderly patient with acute myeloid leukemia refractory to decitabine who responded to treatment with azacitidine K. Galvez, J. Combariza, M. Gomez. Hematology, Hospital Pablo Tobón Uribe, Medellín, Colombia Background: The optimal induction and postremission regimen for older patients with AML has yet to be determined. Furthermore, not all patients are candidates for such therapy. Introduction: There are few reports of patients who have failed treatment with hypomethylating agent who respond to treatment with other hypomethylating agent. Purpose: To present a case report of an elderly patient with AML who responded well to treatment with azacitidine after have been refractory to treatment with decitabine. Materials and Methods: Case report Results: Woman 72 years old, who consults for one month of clinical course consistent deterioration in functional class, dyspnea and pallor, without fever, in whom is documented pancytopenia (leukocytes 1300, 8.8% neutrophils (114), 84% lymphocytes, hemoglobin 10.4, hematocrit 30%, platelets 106,000). The myelogram study, flow cytometry and bone marrow biopsy confirm the diagnosis of acute myeloid leukemia (AML) with monocytic differentiation with myelodysplasia-related changes, with a normal karyotype 46XX and ECOG 2, thus we decided to start treatment with induction chemotherapy with decitabine, after two cycles of treatment the patient persisted with pancytopenia and peripheral blood blasts. With these results it was decided to perform a new bone marrow aspirate and myelogram that evidenced more than 30% blasts. Decitabine refractoriness is considered, it is decided to change the chemotherapy regimen and start azacitidine to 75 mg/m2 /day for 7 days every 4 weeks. With this scheme, she presented severe leukopenia and infections therefore the dose was adjusted to 65 mg/m2 /day. In one of the episodes of febrile neutropenia it was evident ground glass infiltrates in chest CT AR associated with dry cough, empirical voriconazole was started, later positive galactomannan test was
P-176 Hypomethylating therapy in the management of an old older patient with myelodysplastic syndrome followed in a home care program P. Niscola, A. Tendas, M. Palombi, M.M. Trawinska, L. Cupelli, M. Giovannini, L. Scaramucci, G. Catalano, A. Perrotti, P. De Fabritiis. Hematology, S.Eugenio Hospital, Rome, Italy Background: Hypomethylators have significantly changed the clinical scenario of myelodysplastic syndrome (MDS), also in the setting of very old patients. Introduction: We observed a 91 years-old woman who presented with peripheral blood (PB) trilinear pancytopenia, diagnosed as MDS with high transfusion requirements of both packed red blood cells (RBC) and platelets concentrates. Purpose: Because of logistical difficulties for a considerable distance from our Centre, the patient was followed at home by our team of haematological home care. Materials and Methods: During the following months, the patient developed an increased transfusion requirement, a persistent thrombocytopenia (< 3000/uL) with platelet transfusion refractoriness and episodes of muco-cutaneous bleeding. Results: In the absence of significant co-morbidities, she maintained an active life and a satisfactory personal independence in several activities of daily living in her own home, with the support and presence of her loved ones. Two years after MDS diagnosis, having the patient almost 94 years, a BM aspirate was performed. Morphological analysis showed a marked trilinear dysplasia with a 15% of blasts and normal karyotype. allowing the MDS to be classified as (IPSS) intermediate grade 2. After the proper informed consent, 5-azacytidine (75 mg/m2 , schedule 5 + 2 + 2) was started. The treatment was administered on outpatient basis, whereas transfusions and others supportive treatments were given at home. The therapy was well tolerated and cytopenias gradually improved until near PB normalization and complete transfusion independence, achieved after the third course of 5-azacytidine. To date, eight course of 5-azacitidine have been administered; although dysplastic features persisted, marrow aspirated after the sixth course showed absence of blast cells with blood count near normal. Considering hematological response, she will continue 5-azacytidine until side effects or lack of response will contraindicate it. Conclusions: In the light of our experience, targeted studies in the field of geriatric MDS are necessary to formulate guidelines on the appropriate use of hypomethylating therapies in suitable patients. Despite high costs, adequate treatments to preserve QoL and life expectancy for patients in whom a real benefit can be reasonably expected should remain a priority, regardless of age.
Poster Presentations – 12th International Symposium on Myelodysplastic Syndromes / Leukemia Research 37 S1 (2013) S1–S117
confirmed and a biopsy confirmed the presence of an aspergilloma in left maxillary sinus. Regarding its AML with azacitidine scheme, after the third cycle was achieved complete response and so far she has received 12 cycles with this drug well tolerated with no evidence of relapse of hematologic malignancy. At this time, the patient is in good general condition, with adequate quality of life, well tolerated chemotherapy and in treatment of invasive aspergillosis with voriconazole. Conclusions: The treatment with hypomethylating agents has become an option for patients with AML who are not candidates for intensive chemotherapy. These data suggest that it is feasible to use a hypomethylating agent when patients are refractory to other drug of the same class.
Figure 1. Graph of important laboratory parameters which have been related to key stages in the course of the disease.
condition and reversal of coagulopathy with azacitidine strongly suggested that DIC was secondary to MDS. Azacitidine has shown a significantly higher response in patients with monosomy 7 and we postulate that this might have led to reversal of DIC. We suggest a DIC screen should be undertaken in all MDS patients presenting with bleeding symptoms. Clinicians should also be aware of drowsiness as a rare side effect of azacitidine.
P-175 Elderly patient with acute myeloid leukemia refractory to decitabine who responded to treatment with azacitidine K. Galvez, J. Combariza, M. Gomez. Hematology, Hospital Pablo Tobón Uribe, Medellín, Colombia Background: The optimal induction and postremission regimen for older patients with AML has yet to be determined. Furthermore, not all patients are candidates for such therapy. Introduction: There are few reports of patients who have failed treatment with hypomethylating agent who respond to treatment with other hypomethylating agent. Purpose: To present a case report of an elderly patient with AML who responded well to treatment with azacitidine after have been refractory to treatment with decitabine. Materials and Methods: Case report Results: Woman 72 years old, who consults for one month of clinical course consistent deterioration in functional class, dyspnea and pallor, without fever, in whom is documented pancytopenia (leukocytes 1300, 8.8% neutrophils (114), 84% lymphocytes, hemoglobin 10.4, hematocrit 30%, platelets 106,000). The myelogram study, flow cytometry and bone marrow biopsy confirm the diagnosis of acute myeloid leukemia (AML) with monocytic differentiation with myelodysplasia-related changes, with a normal karyotype 46XX and ECOG 2, thus we decided to start treatment with induction chemotherapy with decitabine, after two cycles of treatment the patient persisted with pancytopenia and peripheral blood blasts. With these results it was decided to perform a new bone marrow aspirate and myelogram that evidenced more than 30% blasts. Decitabine refractoriness is considered, it is decided to change the chemotherapy regimen and start azacitidine to 75 mg/m2 /day for 7 days every 4 weeks. With this scheme, she presented severe leukopenia and infections therefore the dose was adjusted to 65 mg/m2 /day. In one of the episodes of febrile neutropenia it was evident ground glass infiltrates in chest CT AR associated with dry cough, empirical voriconazole was started, later positive galactomannan test was
P-176 Hypomethylating therapy in the management of an old older patient with myelodysplastic syndrome followed in a home care program P. Niscola, A. Tendas, M. Palombi, M.M. Trawinska, L. Cupelli, M. Giovannini, L. Scaramucci, G. Catalano, A. Perrotti, P. De Fabritiis. Hematology, S.Eugenio Hospital, Rome, Italy Background: Hypomethylators have significantly changed the clinical scenario of myelodysplastic syndrome (MDS), also in the setting of very old patients. Introduction: We observed a 91 years-old woman who presented with peripheral blood (PB) trilinear pancytopenia, diagnosed as MDS with high transfusion requirements of both packed red blood cells (RBC) and platelets concentrates. Purpose: Because of logistical difficulties for a considerable distance from our Centre, the patient was followed at home by our team of haematological home care. Materials and Methods: During the following months, the patient developed an increased transfusion requirement, a persistent thrombocytopenia (< 3000/uL) with platelet transfusion refractoriness and episodes of muco-cutaneous bleeding. Results: In the absence of significant co-morbidities, she maintained an active life and a satisfactory personal independence in several activities of daily living in her own home, with the support and presence of her loved ones. Two years after MDS diagnosis, having the patient almost 94 years, a BM aspirate was performed. Morphological analysis showed a marked trilinear dysplasia with a 15% of blasts and normal karyotype. allowing the MDS to be classified as (IPSS) intermediate grade 2. After the proper informed consent, 5-azacytidine (75 mg/m2 , schedule 5 + 2 + 2) was started. The treatment was administered on outpatient basis, whereas transfusions and others supportive treatments were given at home. The therapy was well tolerated and cytopenias gradually improved until near PB normalization and complete transfusion independence, achieved after the third course of 5-azacytidine. To date, eight course of 5-azacitidine have been administered; although dysplastic features persisted, marrow aspirated after the sixth course showed absence of blast cells with blood count near normal. Considering hematological response, she will continue 5-azacytidine until side effects or lack of response will contraindicate it. Conclusions: In the light of our experience, targeted studies in the field of geriatric MDS are necessary to formulate guidelines on the appropriate use of hypomethylating therapies in suitable patients. Despite high costs, adequate treatments to preserve QoL and life expectancy for patients in whom a real benefit can be reasonably expected should remain a priority, regardless of age.