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Clinical Trial
, 32 (2), 413-418

A Phase II, Multicentre Trial of Decitabine in Higher-Risk Chronic Myelomonocytic Leukemia

Affiliations
Clinical Trial

A Phase II, Multicentre Trial of Decitabine in Higher-Risk Chronic Myelomonocytic Leukemia

V Santini et al. Leukemia.

Abstract

Chronic myelomonocytic leukemia (CMML) is a complex clonal hematological disorder classified among myelodysplastic (MDS)/myeloproliferative neoplasms. Prognosis is poor and there is a lack of effective treatments. The hypomethylating agent decitabine has shown activity against MDS and elderly acute myeloid leukemia, but there is little data focusing specifically on its efficacy in CMML. In this prospective, phase 2 Italian study, CMML patients received intravenous decitabine 20 mg/m2 per day on Days 1-5 of a 28-day treatment cycle. Response was evaluated after four and six cycles; patients responding at the end of six cycles could continue treatment with decitabine. Forty-three patients were enrolled; >50% were high-risk according to four CMML-specific scoring systems. In the intent-to-treat population (n=42), the overall response rate after six cycles was 47.6%, with seven complete responses (16.6%), eight marrow responses (19%), one partial response (2.4%) and four hematological improvements (9.5%). After a median follow-up of 51.5 months (range: 44.4-57.2), median overall survival was 17 months, with responders having a significantly longer survival than non-responders (P=0.02). Grade 3/4 anemia, neutropenia and thrombocytopenia occurred in 28.6%, 50% and 38% of patients, respectively. Decitabine appears to be an effective and well-tolerated treatment for patients with high-risk CMML.

Conflict of interest statement

The authors declare no conflict of interest. Valeria Santini received honorarium from Janssen Pharmaceutical Companies of Johnson & Johnson in Europe.

Figures

Figure 1
Figure 1
Patient disposition. Flow of patients from enrolment to time of analysis.
Figure 2
Figure 2
Overall survival. Kaplan–Meier curves showing OS in (a) the intent-to-treat (ITT) population and (b) responders vs non-responders. Vertical lines denote censored patients.
Figure 3
Figure 3
Event-free survival. Kaplan–Meier curves showing event-free survival in the intent-to-treat (ITT) population. Vertical lines denote censored patients.
Figure 4
Figure 4
Duration of response. Kaplan–Meier curves showing duration of response. Vertical lines denote censored patients.

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