Dose-finding trial of azacitidine as post-transplant maintenance for high-risk MDS: a KSGCT prospective study

Yuho Najima, Takayoshi Tachibana, Yusuke Takeda, Yuya Koda, Yasuhisa Aoyama, Takashi Toya, Aiko Igarashi, Masatsugu Tanaka, Emiko Sakaida, Ryohei Abe, Makoto Onizuka, Takeshi Kobayashi, Noriko Doki, Kazuteru Ohashi, Heiwa Kanamori, Takuma Ishizaki, Akira Yokota, Satoshi Morita, Shinichiro Okamoto, Yoshinobu Kanda

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5 Citations (Scopus)


This 3+3 dose-escalation phase I multicenter study investigated the optimal dose of azacitidine (AZA) for post-hematopoietic stem cell transplantation (HSCT) maintenance, which remains unknown in Japan. Recipients of a first HSCT for high-risk myelodysplastic syndromes (MDS, n = 12) or acute myeloid leukemia (AML) with antecedent MDS (n = 3) received post-HSCT AZA maintenance in 2015–2019. The optimal AZA dose was defined as the dose at which 50–70% of patients can complete four cycles without dose-limiting toxicity (DLT). The initial dose level 1 was set as 30 mg/m2 for 5 days per 28-day cycle, and dose levels 0, 2, and 3 were set as 20, 40, and 50 mg/m2. DLT was defined as any grade 3 non-hematological or grade 4 hematological toxicity. The 15 evaluable patients were 55 (37–64) years old. The median observation of the post-HSCT survivors was 935 (493–1915) days. The median number of days post-HSCT to the start of AZA was 101 (59–176). In the first, second, and third cohorts, five of nine patients completed four cycles at dose level 1. In the final cohort, five of six additional patients completed at the same dose. In total, 10 (67%) patients tolerated AZA 30 mg/m2, which was determined as optimal. DLT occurred in five cases: grade 3 hepatotoxicity, pneumonia, enterocolitis, and grade 4 thrombocytopenia and neutropenia. The 2-year overall survival and disease-free survival rates post-HSCT were 77.0% and 73.3%. Post-HSCT AZA maintenance was well-tolerated and merits further evaluation for patients with MDS or AML with antecedent MDS.

Original languageEnglish
Pages (from-to)2719-2729
Number of pages11
JournalAnnals of Hematology
Issue number12
Publication statusPublished - 2022 Dec


  • Allogeneic hematopoietic stem cell transplantation
  • Azacitidine
  • Myelodysplastic syndrome
  • Post-transplant maintenance

ASJC Scopus subject areas

  • Hematology


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