Randomized controlled trial of azacitidine in patients with the myelodysplastic syndrome: A study of the Cancer and Leukemia Group B Journal Article


Authors: Silverman, L. R.; Demakos, E. P.; Peterson, B. L.; Kornblith, A. B.; Holland, J. C.; Odchimar-Reissig, R.; Stone, R. M.; Nelson, D.; Powell, B. L.; DeCastro, C. M.; Ellerton, J.; Larson, R. A.; Schiffer, C. A.; Holland, J. F.
Article Title: Randomized controlled trial of azacitidine in patients with the myelodysplastic syndrome: A study of the Cancer and Leukemia Group B
Abstract: Purpose: Patients with high-risk myelodysplastic syndrome (MDS) have high mortality from bone marrow failure or transformation to acute leukemia. Supportive care is standard therapy. We previously reported that azacitidine (Aza C) was active in patients with high-risk MDS. Patients and Methods: A randomized controlled trial was undertaken in 191 patients with MDS to compare Aza C (75 mg/m2/d subcutaneously for 7 days every 28 days) with supportive care. MDS was defined by French-American-British criteria. New rigorous response criteria were applied. Both arms received transfusions and antibiotics as required. Patients in the supportive care arm whose disease worsened were permitted to cross over to Aza C. Results: Responses occurred in 60% of patients on the Aza C arm (7% complete response, 16% partial response, 37% improved) compared with 5% (improved) receiving supportive care (P < .001). Median time to leukemic transformation or death was 21 months for Aza C versus 13 months for supportive care (P = .007). Transformation to acute myelogenous leukemia occurred as the first event in 15% of patients on the Aza C arm and in 38% receiving supportive care (P = .001). Eliminating the confounding effect of early cross-over to Aza C, a landmark analysis after 6 months showed median survival of an additional 18 months for Aza C and 11 months for supportive care (P = .03). Quality-of-life assessment found significant major advantages in physical function, symptoms, and psychological state for patients initially randomized to Aza C. Conclusion: Aza C treatment results in significantly higher response rates, improved quality of life, reduced risk of leukemic transformation, and improved survival compared with supportive care. Aza C provides a new treatment option that is superior to supportive care for patients with the MDS subtypes and specific entry criteria treated in this study. © 2002 by American Society of Clinical Oncology.
Keywords: adult; cancer survival; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; acute granulocytic leukemia; major clinical study; clinical trial; mortality; quality of life; controlled clinical trial; bone marrow; antimetabolites, antineoplastic; nausea; randomized controlled trial; vomiting; risk factors; high risk patient; myelodysplastic syndrome; leukemogenesis; remission induction; intermethod comparison; blood cell count; malignant transformation; injections, subcutaneous; azacitidine; myelodysplastic syndromes; bone marrow depression; cross-over studies; leukemia, b-cell; humans; human; male; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 20
Issue: 10
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2002-05-15
Start Page: 2429
End Page: 2440
Language: English
DOI: 10.1200/jco.2002.04.117
PUBMED: 12011120
PROVIDER: scopus
DOI/URL:
Notes: Export Date: 14 November 2014 -- Source: Scopus
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  1. Jimmie C B Holland
    376 Holland