Massimo Martino, Roberta Fedele, Tiziana Moscato and Francesca RoncoPages 661-669 (9)
Allogeneic hematopoietic progenitor cell transplantation (allo HPCT) is the only potentially curative treatment approach in patients with advanced MDS or AML. Unfortunately, allo HPCT in these settings is limited because most patients are ineligible due to age/comorbidities, or are at a high risk of treatment failure due to disease relapse. Recent studies have shown that azacitidine after allo HPCT increases Treg numbers while inducing a cytotoxic CD8+ T-cell response, suggesting a potential mechanism for augmenting the graft-versus-leukemia (GvL) effect without increasing graft-versushost- disease (GVHD). In patients at a high risk of relapse following allo HPCT, pre-emptive azacitidine may help prevent/delay relapse. For patients who have relapsed following allo HPCT, azacitidine may be a salvage therapy option, either as monotherapy or in combination with donor lymphocyte infusions (DLI). In this mini-review, we discuss these emerging clinical data for HMAs in the post-allo HPCT regimens and highlight the possible future role of azacitidine in this setting.
AML, azacitidine, decitabine, GVHD, GvL, hematopoietic progenitor cell transplant, hypomethylating agents, MDS.
Hematology and Bone Marrow Transplant Unit, Department of Oncology and Hematology, Azienda Ospedaliera BMM, Via Cantaffio, 89133 Reggio Calabria, Italy.