Skip to main content
SpringerLink
Log in

Complete remission after a single cycle of azacitidine in a case of relapsed acute myeloid leukemia

Komplete Remission einer relapsierten akuten myeloischen Leukämie nach einem einzigen Therapiezyklus Azacytidin

  • case report
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Summary

A 75-year-old female patient presented with late relapse of acute myeloid leukemia (AML). She received a single cycle of azacitidine before refusing further treatment. Around 6 weeks after this single azacitidine cycle, complete remission—according to international working group criteria—was observed with continuous improvement in peripheral blood counts to normal values, transfusion-independence, normal blast count (< 5 %) with normal morphology and flow cytometry, as well as a normal bone marrow karyotype and no dysplastic stigmata suggestive of a coexisting myelodysplastic syndrome. The patient also showed a pronounced improvement in performance status. Seven months later a second relapse occurred, followed by one additional azacitidine cycle that showed only a transient and a minor increase in thrombocytes and granulocytes, corresponding to an international working group nonresponse. As azacitidine treatment was interrupted after a single cycle, this case gives insight into the kinetics of response. The lack of response to azacitidine in AML after the second relapse suggests that azacitidine administration should be maintained after response.

Zusammenfassung

Bei einer 75-jährigen Patientin wurde ein Spätrezidiv einer akuten myeloischen Leukämie (AML) diagnostiziert. Sie erhielt einen einzigen Zyklus Azacytidin, verweigerte jedoch dann weitere Therapiezyklen. Sechs Wochen nach der Therapie mit Azacytidin waren die Kriterien einer kompletten Remission gemäß der International Working Group (IWG) erfüllt. Es war nämlich zu einer kontinuierlichen Verbesserung der Blutwerte in den Normbereich, zu Transfusionsfreiheit und einer normalen Blastenzahl (< 5 %) und unauffälligem Karyogramm im Knochenmark gekommen. Zudem wies die Patientin eine signifikante Verbesserung im Performance Status auf. Sieben Monate später trat ein neuerlicher Relaps der AML auf, der wiederum mit Azacytidin behandelt wurde. Es kam lediglich zu einem vorübergehenden und geringfügigen Anstieg der Thrombozyten und Granulozyten, entsprechend einem non-response nach IWG. Dieser Fallbericht gibt Einblick in die Response-Kinetik auf Azacytidin. Das fehlende Ansprechen der akuten myeloischen Leukämie auf den zweiten Azacytidin Zyklus weist darauf hin, dass die Azacytidin Gabe nach einem Ansprechen unbedingt weitergeführt werden sollte.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Dohner H, Estey EH, Amadori S, et al. Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood. 2010;115(3):453–74.

    Article  PubMed  Google Scholar 

  2. Fenaux P, Mufti GJ, Hellstrom-Lindberg E, et al. Azacitidine prolongs overall survival compared with conventional care regimens in elderly patients with low bone marrow blast count acute myeloid leukemia. J Clin Oncol. 2010;28(4):562–9.

    Article  PubMed  CAS  Google Scholar 

  3. Seymour JF, Fenaux P, Silverman LR, et al. Effects of azacitidine compared with conventional care regimens in elderly (³  75 years) patients with higher-risk myelodysplastic syndromes. Crit Rev Oncol Hematol. 2010;76(3):218–27.

    Article  PubMed  Google Scholar 

  4. Sudan N, Rossetti JM, Shadduck RK, et al. Treatment of acute myelogenous leukemia with outpatient azacitidine. Cancer. 2006;107(8):1839–43.

    Article  PubMed  CAS  Google Scholar 

  5. Al-Ali HK, Jaekel N, Junghanss C, et al. Azacitidine in patients with acute myeloid leukemia medically unfit for or resistant to chemotherapy: a multicenter phase I/II study. Leukemia Lymphoma. 2012;53(1):110–7.

    Article  PubMed  CAS  Google Scholar 

  6. Sorror ML, Maris MB, Storb R, et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood. 2005;106(8):2912–9.

    Article  PubMed  CAS  Google Scholar 

  7. Maurillo L, Venditti A, Spagnoli A, et al. Azacitidine for the treatment of patients with acute myeloid leukemia: report of 82 patients enrolled in an Italian compassionate program. Cancer. 2012;118(4):1014–22.

    Article  PubMed  CAS  Google Scholar 

  8. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.

    Article  PubMed  CAS  Google Scholar 

  9. Thepot S, Itzykson R, Seegers V, et al. Treatment of progression of Philadelphia-negative myeloproliferative neoplasms to myelodysplastic syndrome or acute myeloid leukemia by azacitidine: a report on 54 cases on the behalf of the Groupe Francophone des Myelodysplasies (GFM). Blood. 2010;116(19):3735–42.

    Article  PubMed  CAS  Google Scholar 

  10. van der Helm LH, Alhan C, Wijermans PW, et al. Platelet doubling after the first azacitidine cycle is a promising predictor for response in myelodysplastic syndromes (MDS), chronic myelomonocytic leukaemia (CMML) and acute myeloid leukaemia (AML) patients in the Dutch azacitidine compassionate named patient programme. Br J Haematol. 2011;155(5):599–606.

    Article  PubMed  CAS  Google Scholar 

  11. Silverman LR, McKenzie DR, Peterson BL, et al. Further analysis of trials with azacitidine in patients with myelodysplastic syndrome: studies 8421, 8921, and 9221 by the Cancer and Leukemia Group B. J Clin Oncol. 2006;24(24):3895–903.

    Article  PubMed  CAS  Google Scholar 

  12. Muller-Thomas C, Schuster T, Peschel C, Gotze KS.A limited number of 5-azacitidine cycles can be effective treatment in MDS. Ann Hematol. 2009;88(3):213–9.

    Article  PubMed  Google Scholar 

  13. Itzykson R, Thepot S, Quesnel B, et al. Prognostic factors for response and overall survival in 282 patients with higher-risk myelodysplastic syndromes treated with azacitidine. Blood. 2011;117(2):403–11.

    Article  PubMed  CAS  Google Scholar 

  14. Pleyer L, Stauder R, Burgstaller S, et al. Azacitidine in patients with WHO-defined AML—Results of 155 patients from the Austrian Azacitidine Registry (AAR) of the AGMT-Study Group. Submitted for publication.

  15. Santini V, Fenaux P, Mufti GJ, et al. Management and supportive care measures for adverse events in patients with myelodysplastic syndromes treated with azacitidine. Eur J Haematol. 2010;85(2):130–8.

    PubMed  CAS  Google Scholar 

  16. Stauder R. The challenge of individualised risk assessment and therapy planning in elderly high-risk myelodysplastic syndromes (MDS) patients. Ann Hematol. 2012;91(9):1333–43.

    Article  PubMed  Google Scholar 

  17. Fenaux P, Bowen D, Gattermann N, et al. Practical use of azacitidine in higher-risk myelodysplastic syndromes: an expert panel opinion. Leuk Res. 2010;34(11):1410–6.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria

    Christine Valentiny MD, Martina Mitrovic MSc, Michael Steurer MD, Wolfgang Willenbacher MD &  Reinhard Stauder MD, MSc

  2. Department of Internal Medicine III, Paracelsus Private Medical University, Salzburg, Austria

    Lisa Pleyer MD, DI biomed.inf.

Authors
  1. Christine Valentiny MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martina Mitrovic MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lisa Pleyer MD, DI biomed.inf.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Steurer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wolfgang Willenbacher MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Reinhard Stauder MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Reinhard Stauder MD, MSc.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Valentiny, C., Mitrovic, M., Pleyer, L. et al. Complete remission after a single cycle of azacitidine in a case of relapsed acute myeloid leukemia. Wien Klin Wochenschr 125, 50–53 (2013). https://doi.org/10.1007/s00508-012-0319-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-012-0319-6

Keywords

Schlüsselwörter

Search

Navigation