Reactions 1391 - 3 Mar 2012

SAntineoplastics

Myelodysplastic syndromes, treated withazacitidine: 4 case reports

Four men with non-Hodgkin’s lymphoma (NHL)developed myelodysplastic syndromes after receivingantineoplastics [dosages and routes not stated]; three ofthem responded to treatment with azacitidine.

A 54-year-old man received fludarabine,cyclophosphamide and rituximab (FCR regimen) from Juneto November 2008 (6 cycles). He achieved completeremission in January 2009 and remained off therapy for13 months, when cytopenia was noted. In February 2010,bone marrow analysis revealed severe trilineage dysplasiawith 10% blast cells and cytogenetic aberrations. Hereceived azacitidine 75 mg/m2 according to a 5+2+2schedule (5 days on, 2 days off, 2 days on). After the fourthcycle, his blood counts showed normal values, and bonemarrow examination revealed absence of blast cells and acomplete cytogenetic response. He continued azacitidinetreatment while waiting for a bone marrow transplant.

A 62-year-old man started chemotherapy with rituximab,cyclophosphamide, vincristine, doxorubicin andprednisone (R-CHOP; 6 cycles) from September 2005 toJanuary 2006. He then received ifosfamide, epirubicin andetoposide (IEV; 3 cycles) from February to May 2007,followed by rituximab, dexamethasone, cytarabine andcisplatin (R-DHAP) from March to July 2008. After a relapsein November 2008, he received ibritumomab tiuxetan[duration of treatment not stated]. In November 2009,4 months after completing chemotherapy with vincristine,doxorubicin, etoposide, cyclophosphamide, bleomycinand prednisolone (P-VABEC; 8 cycles), he developedrefractory cytopenia with multilineage dysplasia. Testsshowed 4% bone marrow blast cells and cytogeneticaberrations. He received erythropoietin and transfusionsand started receiving azacitidine 75 mg/m2 in March 2010according to a 5+2+2 schedule. His blood counts hadimproved after 5 cycles, but he died in August 2010 fromcardiac failure.

A man was diagnosed with large B-cell NHL in May 1997at 42 years of age and received 6 cycles of methotrexate,folinic acid [leucovorin], doxorubicin, cyclophosphamide,vincristine, bleomycin and prednisone (MACOP-B),followed by a stem cell transplant. In June 2009, hepresented with severe anaemia, thrombocytopenia andleucopenia. Bone marrow analysis showed severetrilineage dysplasia with 5% blast cells. He started receivingazacitidine in October 2010, and after 5 cycles, bonemarrow analysis showed absence of blast cells andmoderate dysplasia. He continued azacitidine treatmentwhile waiting for a bone marrow transplant.

A 66-year-old man received cyclophosphamide,vincristine, doxorubicin and prednisone (CHOP) fromSeptember 2000 to August 2001. After a relapse in June2006, he received 6 cycles of FCR until December 2006,followed by 3 cycles of rituximab alone until April 2008. InJanuary 2010, he developed anaemia, leucopenia andthrombocytopenia. He was diagnosed with refractorycytopenia, with multilineage dysplasia and cytogeneticaberrations. From July 2010, he received 6 cycles ofazacitidine but did not respond. Bone marrow analysis,performed after the fifth cycle, revealed persistenttrilineage dysplasia.Breccia M, et al. 5’-Azacitidine for therapy-related myelodysplastic syndromesafter non-Hodgkin lymphoma treatment. Leukemia Research 35: 1409-11, No. 10,Oct 2011 - Italy 803067617

1

Reactions 3 Mar 2012 No. 13910114-9954/10/1391-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved