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Response to upfront azacitidine in juvenile myelomonocytic leukemia in the AZA-JMML-001 trial

Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative therapy for most children with juvenile myelomonocytic leukemia (JMML). Novel therapies controlling the disorder prior to HSCT are needed. We conducted a phase 2, multicenter, open-label study to evaluate the safety and a...

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Main Authors: Niemeyer, Charlotte (Author) , Flotho, Christian (Author) , Lipka, Daniel (Author) , Starý, Jan (Author) , Rössig, Claudia (Author) , Baruchel, André (Author) , Klingebiel, Thomas (Author) , Micalizzi, Concetta (Author) , Michel, Gérard (Author) , Nysom, Karsten (Author) , Rives, Susana (Author) , Schmugge Liner, Markus (Author) , Zecca, Marco (Author) , Schönung, Maximilian (Author) , Baumann, Irith (Author) , Nöllke, Peter (Author) , Benettaib, Bouchra (Author) , Biserna, Noha (Author) , Poon, Jennifer (Author) , Simcock, Mathew (Author) , Patturajan, Meera (Author) , Menezes, Daniel (Author) , Gaudy, Allison (Author) , van den Heuvel-Eibrink, Marry M. (Author) , Locatelli, Franco (Author)
Format: Article (Journal)
Language:English
Published: 23 July 2021
In: Blood advances
Year: 2021, Volume: 5, Issue: 14, Pages: 2901-2908
ISSN:2473-9537
DOI:10.1182/bloodadvances.2020004144
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1182/bloodadvances.2020004144
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Author Notes:Charlotte M. Niemeyer, Christian Flotho, Daniel B. Lipka, Jan Starý, Claudia Rössig, André Baruchel, Thomas Klingebiel, Concetta Micalizzi, Gérard Michel, Karsten Nysom, Susana Rives, Markus Schmugge Liner, Marco Zecca, Maximilian Schönung, Irith Baumann, Peter Nöllke, Bouchra Benettaib, Noha Biserna, Jennifer Poon, Mathew Simcock, Meera Patturajan, Daniel Menezes, Allison Gaudy, Marry M. van den Heuvel-Eibrink, and Franco Locatelli
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Summary:Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative therapy for most children with juvenile myelomonocytic leukemia (JMML). Novel therapies controlling the disorder prior to HSCT are needed. We conducted a phase 2, multicenter, open-label study to evaluate the safety and antileukemic activity of azacitidine monotherapy prior to HSCT in newly diagnosed JMML patients. Eighteen patients enrolled from September 2015 to November 2017 were treated with azacitidine (75 mg/m2) administered IV once daily on days 1 to 7 of a 28-day cycle. The primary end point was the number of patients with clinical complete remission (cCR) or clinical partial remission (cPR) after 3 cycles of therapy. Pharmacokinetics, genome-wide DNA-methylation levels, and variant allele frequencies of leukemia-specific index mutations were also analyzed. Sixteen patients completed 3 cycles and 5 patients completed 6 cycles. After 3 cycles, 11 patients (61%) were in cPR and 7 (39%) had progressive disease. Six of 16 patients (38%) who needed platelet transfusions were transfusion-free after 3 cycles. All 7 patients with intermediate- or low-methylation signatures in genome-wide DNA-methylation studies achieved cPR. Seventeen patients received HSCT; 14 (82%) were leukemia-free at a median follow-up of 23.8 months (range, 7.0-39.3 months) after HSCT. Azacitidine was well tolerated and plasma concentration--time profiles were similar to observed profiles in adults. In conclusion, azacitidine monotherapy is a suitable option for children with newly diagnosed JMML. Although long-term safety and efficacy remain to be fully elucidated in this population, these data demonstrate that azacitidine provides valuable clinical benefit to JMML patients prior to HSCT. This trial was registered at www.clinicaltrials.gov as #NCT02447666.
Item Description:Gesehen am 25.10.2021
Physical Description:Online Resource
ISSN:2473-9537
DOI:10.1182/bloodadvances.2020004144

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