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Donnette M, Hamimed M, Ciccolini J, Sicard G, Correard F, Farnault L, Ouafik L, Venton G, Fanciullino R. Cytidine deaminase status as a marker of response to azacytidine treatment in MDS and AML patients. Br J Haematol 2023; 203:625-636. [PMID: 37691342 DOI: 10.1111/bjh.19096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 09/12/2023]
Abstract
Azacitidine (Aza) is a mainstay of treatment for patients with acute myeloid leukaemia (AML) ineligible for induction chemotherapy and other high-risk myelodysplastic syndromes (MDS). Only half of patients respond, and almost all will eventually relapse. There are no predictive markers of response to Aza. Aza is detoxified in the liver by cytidine deaminase (CDA). Here, we investigated the association between CDA phenotype, toxicity and efficacy of Aza in real-world adult patients. Median overall survival (OS) was 15 months and 13 months in AML and high-risk MDS patients respectively. In addition, our data suggest that delaying Aza treatment was not associated with lack of efficacy and should not be considered a signal to switch to an alternative treatment. Half of the patients had deficient CDA activity (i.e. <2 UA/mg), with a lower proportion of deficient patients in MDS patients (34%) compared to AML patients (67%). In MDS patients, CDA deficiency correlated with longer landmark OS (14 vs. 8 months; p = 0.03), but not in AML patients. Taken together, our data suggest that CDA is an independent covariate and may therefore be a marker for predicting clinical outcome in MDS patients treated with Aza.
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Affiliation(s)
- Melanie Donnette
- SMARTc: Simulation and Modeling: Adaptative Response for Therapeutics in Cancer, Faculté de Pharmacie de Marseille, CRCM Inserm UMR 1068, Marseille, France
- Faculté de Pharmacie de Marseille, COMPO, CRCM Inserm UMR 1068, INRIA Sophia Antipolis, Marseille, France
| | - Mourad Hamimed
- SMARTc: Simulation and Modeling: Adaptative Response for Therapeutics in Cancer, Faculté de Pharmacie de Marseille, CRCM Inserm UMR 1068, Marseille, France
- Faculté de Pharmacie de Marseille, COMPO, CRCM Inserm UMR 1068, INRIA Sophia Antipolis, Marseille, France
| | - Joseph Ciccolini
- SMARTc: Simulation and Modeling: Adaptative Response for Therapeutics in Cancer, Faculté de Pharmacie de Marseille, CRCM Inserm UMR 1068, Marseille, France
- Faculté de Pharmacie de Marseille, COMPO, CRCM Inserm UMR 1068, INRIA Sophia Antipolis, Marseille, France
- Laboratoire de Pharmacocinétique et Toxicologie, La Timone University Hospital of Marseille, Marseille, France
| | - Guillaume Sicard
- SMARTc: Simulation and Modeling: Adaptative Response for Therapeutics in Cancer, Faculté de Pharmacie de Marseille, CRCM Inserm UMR 1068, Marseille, France
- Faculté de Pharmacie de Marseille, COMPO, CRCM Inserm UMR 1068, INRIA Sophia Antipolis, Marseille, France
| | - Florian Correard
- Pharmacie, La Timone University Hospital of Marseille, Marseille, France
| | - Laure Farnault
- Hematology and Cellular Therapy Department, La Conception University Hospital of Marseille, Marseille, France
| | - L'Houcine Ouafik
- Laboratoire de Transfert en Oncologie Biologie, Nord University Hispoital of Marseille, Marseille, France
| | - Geoffroy Venton
- Hematology and Cellular Therapy Department, La Conception University Hospital of Marseille, Marseille, France
| | - Raphaëlle Fanciullino
- SMARTc: Simulation and Modeling: Adaptative Response for Therapeutics in Cancer, Faculté de Pharmacie de Marseille, CRCM Inserm UMR 1068, Marseille, France
- Faculté de Pharmacie de Marseille, COMPO, CRCM Inserm UMR 1068, INRIA Sophia Antipolis, Marseille, France
- Pharmacie de La Conception University Hospital Of Marseille, Marseille, France
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Silla L, Dulley F, Saboya R, Kerbauy F, de Moraes Arantes A, Pezzi A, Gross LG, Paton E, Hamerschlak N. Brazilian guidelines on hematopoietic stem cell transplantation in acute myeloid leukemia. Eur J Haematol 2016; 98:177-183. [PMID: 27621140 DOI: 10.1111/ejh.12808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION/OBJECTIVES Acute myeloid leukemia (AML) accounts for 90% of all cases of acute leukemia in adults. In Brazil, the mortality from myeloid leukemia is 1.74/100 000 men and 1.37/100 000 women. Our aim was to review and update guidelines of the Brazilian Society of Bone Marrow Transplantation on indications of hematopoietic stem cell transplantation (HSCT) for the treatment AML. CONCLUSIONS (i) Allo-HSCT is recommended for high-risk AML (IA); (ii) allo-HSCT is recommended for AML of intermediate risk (IA); (iii) allo-HSCT is recommended for AML relapsed/refractory (C4); (iv) auto-HSCT is recommended for AML after 1 consolidation (C4); (v) auto-HSCT is recommended for AML in CR1 (higher than QT in the Brazilian experience) (C4); (vi) auto-HSCT is accepted for AML M3 in second molecular complete remission (2B); (vii) peripheral blood instead of Bone Marrow HSC for advanced disease (2A); (viii) recommended conditioning protocols: Bu-Cy/Bu-Mel, Bu-Flu, TBI-Cy. In umbilical cord HSCT, consider ATG-based protocols (2A); (ix) allogeneic HSCT for the treatment of AML can be used in patients between 60 and 80 yr with good performance status and the absence of significant comorbidities (C4).
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Affiliation(s)
- Lucia Silla
- Cellular Therapy Program HCPA, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Frederico Dulley
- Bone Marrow Transplantation Unit, Hospital Inglês, São Paulo, Brazil
| | - Rosaura Saboya
- Bone Marrow Transplantation Unit, Hospital Inglês, São Paulo, Brazil
| | - Fabio Kerbauy
- Hematology and Bone Marrow Transplantation Unit, Hospital Albert Einstein e UNIFESP, São Paulo, Brazil
| | | | - Annelise Pezzi
- Cellular Therapy Program HCPA, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Eduardo Paton
- Bone Marrow Transplantation Unit, Hospital de Cancer de Barretos, Barretos, Brazil
| | - Nelson Hamerschlak
- Hematology and Bone Marrow Transplantation Unit, Hospital Albert Einstein e UNIFESP, São Paulo, Brazil
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