Difference between revisions of "Chronic myelomonocytic leukemia"
Jump to navigation
Jump to search
Warner-admin (talk | contribs) m (Text replacement - "http://www.nature.com" to "https://www.nature.com") |
m |
||
| Line 1: | Line 1: | ||
| − | |||
| − | |||
| − | |||
{| class="wikitable" style="text-align:center; width:50%;" | {| class="wikitable" style="text-align:center; width:50%;" | ||
!colspan="2" align="center" style="color:white; font-size:125%; background-color:#de2d26"|'''Section editor''' | !colspan="2" align="center" style="color:white; font-size:125%; background-color:#de2d26"|'''Section editor''' | ||
| Line 38: | Line 35: | ||
|- | |- | ||
|rowspan=2|[http://ascopubs.org/doi/full/10.1200/JCO.2015.66.2510 Sekeres et al. 2017 (SWOG S1117)] | |rowspan=2|[http://ascopubs.org/doi/full/10.1200/JCO.2015.66.2510 Sekeres et al. 2017 (SWOG S1117)] | ||
| − | |rowspan=2 style="background-color:#91cf61"|Randomized Phase II, <20 pts in subgroup | + | |rowspan=2 style="background-color:#91cf61"|Randomized Phase II, <20 pts in subgroup (C) |
|[[#Azacitidine_.26_Lenalidomide|Azacitidine & Lenalidomide]] | |[[#Azacitidine_.26_Lenalidomide|Azacitidine & Lenalidomide]] | ||
|style="background-color:#ffffbf"|Seems not superior | |style="background-color:#ffffbf"|Seems not superior | ||
| Line 64: | Line 61: | ||
|- | |- | ||
|rowspan=2|[http://ascopubs.org/doi/full/10.1200/JCO.2015.66.2510 Sekeres et al. 2017 (SWOG S1117)] | |rowspan=2|[http://ascopubs.org/doi/full/10.1200/JCO.2015.66.2510 Sekeres et al. 2017 (SWOG S1117)] | ||
| − | |rowspan=2 style="background-color:#91cf61"|Randomized Phase II, <20 pts in subgroup | + | |rowspan=2 style="background-color:#91cf61"|Randomized Phase II, <20 pts in subgroup (C) |
|[[#Azacitidine_.26_Lenalidomide|Azacitidine & Lenalidomide]] | |[[#Azacitidine_.26_Lenalidomide|Azacitidine & Lenalidomide]] | ||
|style="background-color:#ffffbf"|Seems not superior | |style="background-color:#ffffbf"|Seems not superior | ||
| Line 79: | Line 76: | ||
===References=== | ===References=== | ||
# Drummond MW, Pocock C, Boissinot M, Mills J, Brown J, Cauchy P, Cross NC, Hartley S, Kell J, Szubert A, Cockerill PN, Bowen DT. A multi-centre phase 2 study of azacitidine in chronic myelomonocytic leukaemia. Leukemia. 2014 Jul;28(7):1570-2. Epub 2014 Feb 26. [https://www.nature.com/leu/journal/v28/n7/full/leu201485a.html link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/24569776 PubMed] | # Drummond MW, Pocock C, Boissinot M, Mills J, Brown J, Cauchy P, Cross NC, Hartley S, Kell J, Szubert A, Cockerill PN, Bowen DT. A multi-centre phase 2 study of azacitidine in chronic myelomonocytic leukaemia. Leukemia. 2014 Jul;28(7):1570-2. Epub 2014 Feb 26. [https://www.nature.com/leu/journal/v28/n7/full/leu201485a.html link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/24569776 PubMed] | ||
| − | # Sekeres MA, Othus M, List AF, Odenike O, Stone RM, Gore SD, Litzow MR, Buckstein R, Fang M, Roulston D, Bloomfield CD, Moseley A, Nazha A, Zhang Y, Velasco MR, Gaur R, Atallah E, Attar EC, Cook EK, Cull AH, Rauh MJ, Appelbaum FR, Erba HP. Randomized phase II study of azacitidine alone or in combination with lenalidomide or with vorinostat in higher-risk myelodysplastic syndromes and chronic myelomonocytic leukemia: North American Intergroup Study SWOG S1117. J Clin Oncol. 2017 Aug 20;35(24):2745-2753. Epub 2017 May 9. [http://ascopubs.org/doi/full/10.1200/JCO.2015.66.2510 link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/28486043 PubMed] | + | # '''SWOG S1117:''' Sekeres MA, Othus M, List AF, Odenike O, Stone RM, Gore SD, Litzow MR, Buckstein R, Fang M, Roulston D, Bloomfield CD, Moseley A, Nazha A, Zhang Y, Velasco MR, Gaur R, Atallah E, Attar EC, Cook EK, Cull AH, Rauh MJ, Appelbaum FR, Erba HP. Randomized phase II study of azacitidine alone or in combination with lenalidomide or with vorinostat in higher-risk myelodysplastic syndromes and chronic myelomonocytic leukemia: North American Intergroup Study SWOG S1117. J Clin Oncol. 2017 Aug 20;35(24):2745-2753. Epub 2017 May 9. [http://ascopubs.org/doi/full/10.1200/JCO.2015.66.2510 link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/28486043 PubMed] |
==Azacitidine & Lenalidomide {{#subobject:92571f|Regimen=1}}== | ==Azacitidine & Lenalidomide {{#subobject:92571f|Regimen=1}}== | ||
| Line 94: | Line 91: | ||
|- | |- | ||
|rowspan=2|[http://ascopubs.org/doi/full/10.1200/JCO.2015.66.2510 Sekeres et al. 2017 (SWOG S1117)] | |rowspan=2|[http://ascopubs.org/doi/full/10.1200/JCO.2015.66.2510 Sekeres et al. 2017 (SWOG S1117)] | ||
| − | |rowspan=2 style="background-color:#91cf61"|Randomized Phase II, <20 pts in subgroup | + | |rowspan=2 style="background-color:#91cf61"|Randomized Phase II, <20 pts in subgroup (E) |
|[[#Azacitidine_monotherapy|Azacitidine]] | |[[#Azacitidine_monotherapy|Azacitidine]] | ||
|style="background-color:#ffffbf"|Seems not superior | |style="background-color:#ffffbf"|Seems not superior | ||
| Line 116: | Line 113: | ||
|- | |- | ||
|rowspan=2|[http://ascopubs.org/doi/full/10.1200/JCO.2015.66.2510 Sekeres et al. 2017 (SWOG S1117)] | |rowspan=2|[http://ascopubs.org/doi/full/10.1200/JCO.2015.66.2510 Sekeres et al. 2017 (SWOG S1117)] | ||
| − | |rowspan=2 style="background-color:#91cf61"|Randomized Phase II, <20 pts in subgroup | + | |rowspan=2 style="background-color:#91cf61"|Randomized Phase II, <20 pts in subgroup (E) |
|[[#Azacitidine_monotherapy|Azacitidine]] | |[[#Azacitidine_monotherapy|Azacitidine]] | ||
|style="background-color:#ffffbf"|Seems not superior | |style="background-color:#ffffbf"|Seems not superior | ||
| Line 131: | Line 128: | ||
===References=== | ===References=== | ||
| − | # Sekeres MA, Othus M, List AF, Odenike O, Stone RM, Gore SD, Litzow MR, Buckstein R, Fang M, Roulston D, Bloomfield CD, Moseley A, Nazha A, Zhang Y, Velasco MR, Gaur R, Atallah E, Attar EC, Cook EK, Cull AH, Rauh MJ, Appelbaum FR, Erba HP. Randomized phase II study of azacitidine alone or in combination with lenalidomide or with vorinostat in higher-risk myelodysplastic syndromes and chronic myelomonocytic leukemia: North American Intergroup Study SWOG S1117. J Clin Oncol. 2017 Aug 20;35(24):2745-2753. Epub 2017 May 9. [http://ascopubs.org/doi/full/10.1200/JCO.2015.66.2510 link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/28486043 PubMed] | + | # '''SWOG S1117:''' Sekeres MA, Othus M, List AF, Odenike O, Stone RM, Gore SD, Litzow MR, Buckstein R, Fang M, Roulston D, Bloomfield CD, Moseley A, Nazha A, Zhang Y, Velasco MR, Gaur R, Atallah E, Attar EC, Cook EK, Cull AH, Rauh MJ, Appelbaum FR, Erba HP. Randomized phase II study of azacitidine alone or in combination with lenalidomide or with vorinostat in higher-risk myelodysplastic syndromes and chronic myelomonocytic leukemia: North American Intergroup Study SWOG S1117. J Clin Oncol. 2017 Aug 20;35(24):2745-2753. Epub 2017 May 9. [http://ascopubs.org/doi/full/10.1200/JCO.2015.66.2510 link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/28486043 PubMed] |
==Azacitidine & Vorinostat {{#subobject:a816bd|Regimen=1}}== | ==Azacitidine & Vorinostat {{#subobject:a816bd|Regimen=1}}== | ||
| Line 146: | Line 143: | ||
|- | |- | ||
|rowspan=2|[http://ascopubs.org/doi/full/10.1200/JCO.2015.66.2510 Sekeres et al. 2017 (SWOG S1117)] | |rowspan=2|[http://ascopubs.org/doi/full/10.1200/JCO.2015.66.2510 Sekeres et al. 2017 (SWOG S1117)] | ||
| − | |rowspan=2 style="background-color:#91cf61"|Randomized Phase II, <20 pts in subgroup | + | |rowspan=2 style="background-color:#91cf61"|Randomized Phase II, <20 pts in subgroup (E) |
|[[#Azacitidine_monotherapy|Azacitidine]] | |[[#Azacitidine_monotherapy|Azacitidine]] | ||
|style="background-color:#ffffbf"|Seems not superior | |style="background-color:#ffffbf"|Seems not superior | ||
| Line 168: | Line 165: | ||
|- | |- | ||
|rowspan=2|[http://ascopubs.org/doi/full/10.1200/JCO.2015.66.2510 Sekeres et al. 2017 (SWOG S1117)] | |rowspan=2|[http://ascopubs.org/doi/full/10.1200/JCO.2015.66.2510 Sekeres et al. 2017 (SWOG S1117)] | ||
| − | |rowspan=2 style="background-color:#91cf61"|Randomized Phase II, <20 pts in subgroup | + | |rowspan=2 style="background-color:#91cf61"|Randomized Phase II, <20 pts in subgroup (E) |
|[[#Azacitidine_monotherapy|Azacitidine]] | |[[#Azacitidine_monotherapy|Azacitidine]] | ||
|style="background-color:#ffffbf"|Seems not superior | |style="background-color:#ffffbf"|Seems not superior | ||
| Line 183: | Line 180: | ||
===References=== | ===References=== | ||
| − | # Sekeres MA, Othus M, List AF, Odenike O, Stone RM, Gore SD, Litzow MR, Buckstein R, Fang M, Roulston D, Bloomfield CD, Moseley A, Nazha A, Zhang Y, Velasco MR, Gaur R, Atallah E, Attar EC, Cook EK, Cull AH, Rauh MJ, Appelbaum FR, Erba HP. Randomized phase II study of azacitidine alone or in combination with lenalidomide or with vorinostat in higher-risk myelodysplastic syndromes and chronic myelomonocytic leukemia: North American Intergroup Study SWOG S1117. J Clin Oncol. 2017 Aug 20;35(24):2745-2753. Epub 2017 May 9. [http://ascopubs.org/doi/full/10.1200/JCO.2015.66.2510 link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/28486043 PubMed] | + | # '''SWOG S1117:''' Sekeres MA, Othus M, List AF, Odenike O, Stone RM, Gore SD, Litzow MR, Buckstein R, Fang M, Roulston D, Bloomfield CD, Moseley A, Nazha A, Zhang Y, Velasco MR, Gaur R, Atallah E, Attar EC, Cook EK, Cull AH, Rauh MJ, Appelbaum FR, Erba HP. Randomized phase II study of azacitidine alone or in combination with lenalidomide or with vorinostat in higher-risk myelodysplastic syndromes and chronic myelomonocytic leukemia: North American Intergroup Study SWOG S1117. J Clin Oncol. 2017 Aug 20;35(24):2745-2753. Epub 2017 May 9. [http://ascopubs.org/doi/full/10.1200/JCO.2015.66.2510 link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/28486043 PubMed] |
==Decitabine monotherapy {{#subobject:c9cd47|Regimen=1}}== | ==Decitabine monotherapy {{#subobject:c9cd47|Regimen=1}}== | ||
Revision as of 12:16, 8 August 2018
| Section editor | |
|---|---|
 |
Sanjay R. Mohan, MD, MSCI Nashville, TN |
7 regimens on this page
10 variants on this page
|
Guidelines
International expert panel
- Allogeneic hematopoietic stem cell transplantation for MDS and CMML: recommendations from an international expert panel. (2017) PubMed
NCCN
First-line therapy
Azacitidine monotherapy
| back to top |
Variant #1, 7 days
| Study | Evidence | Comparator | Efficacy |
|---|---|---|---|
| Sekeres et al. 2017 (SWOG S1117) | Randomized Phase II, <20 pts in subgroup (C) | Azacitidine & Lenalidomide | Seems not superior |
| Azacitidine & Vorinostat | Seems not superior |
Chemotherapy
- Azacitidine (Vidaza) 75 mg/m2 SC/IV once per day on days 1 to 7
28-day cycles
Variant #2, 5-2-2
| Study | Evidence | Comparator | Efficacy |
|---|---|---|---|
| Drummond et al. 2014 | Phase II | ||
| Sekeres et al. 2017 (SWOG S1117) | Randomized Phase II, <20 pts in subgroup (C) | Azacitidine & Lenalidomide | Seems not superior |
| Azacitidine & Vorinostat | Seems not superior |
Chemotherapy
- Azacitidine (Vidaza) 75 mg/m2 IV once per day on days 1 to 5, 8 & 9
28-day cycle for at least 6 cycles, then continued for responders or SD until progression or intolerance.
References
- Drummond MW, Pocock C, Boissinot M, Mills J, Brown J, Cauchy P, Cross NC, Hartley S, Kell J, Szubert A, Cockerill PN, Bowen DT. A multi-centre phase 2 study of azacitidine in chronic myelomonocytic leukaemia. Leukemia. 2014 Jul;28(7):1570-2. Epub 2014 Feb 26. link to original article contains verified protocol PubMed
- SWOG S1117: Sekeres MA, Othus M, List AF, Odenike O, Stone RM, Gore SD, Litzow MR, Buckstein R, Fang M, Roulston D, Bloomfield CD, Moseley A, Nazha A, Zhang Y, Velasco MR, Gaur R, Atallah E, Attar EC, Cook EK, Cull AH, Rauh MJ, Appelbaum FR, Erba HP. Randomized phase II study of azacitidine alone or in combination with lenalidomide or with vorinostat in higher-risk myelodysplastic syndromes and chronic myelomonocytic leukemia: North American Intergroup Study SWOG S1117. J Clin Oncol. 2017 Aug 20;35(24):2745-2753. Epub 2017 May 9. link to original article contains verified protocol PubMed
Azacitidine & Lenalidomide
| back to top |
Variant #1, 7 days of azacitidine
| Study | Evidence | Comparator | Efficacy |
|---|---|---|---|
| Sekeres et al. 2017 (SWOG S1117) | Randomized Phase II, <20 pts in subgroup (E) | Azacitidine | Seems not superior |
| Azacitidine & Vorinostat | Not reported |
Chemotherapy
- Azacitidine (Vidaza) 75 mg/m2 SC/IV once per day on days 1 to 7
- Lenalidomide (Revlimid) 10 mg PO once per day on days 1 to 21
28-day cycles
Variant #2, 5-2-2 azacitidine
| Study | Evidence | Comparator | Efficacy |
|---|---|---|---|
| Sekeres et al. 2017 (SWOG S1117) | Randomized Phase II, <20 pts in subgroup (E) | Azacitidine | Seems not superior |
| Azacitidine & Vorinostat | Not reported |
Chemotherapy
- Azacitidine (Vidaza) 75 mg/m2 SC/IV once per day on days 1 to 5, 8 & 9
- Lenalidomide (Revlimid) 10 mg PO once per day on days 1 to 21
28-day cycles
References
- SWOG S1117: Sekeres MA, Othus M, List AF, Odenike O, Stone RM, Gore SD, Litzow MR, Buckstein R, Fang M, Roulston D, Bloomfield CD, Moseley A, Nazha A, Zhang Y, Velasco MR, Gaur R, Atallah E, Attar EC, Cook EK, Cull AH, Rauh MJ, Appelbaum FR, Erba HP. Randomized phase II study of azacitidine alone or in combination with lenalidomide or with vorinostat in higher-risk myelodysplastic syndromes and chronic myelomonocytic leukemia: North American Intergroup Study SWOG S1117. J Clin Oncol. 2017 Aug 20;35(24):2745-2753. Epub 2017 May 9. link to original article contains verified protocol PubMed
Azacitidine & Vorinostat
| back to top |
Variant #1, 7 days of azacitidine
| Study | Evidence | Comparator | Efficacy |
|---|---|---|---|
| Sekeres et al. 2017 (SWOG S1117) | Randomized Phase II, <20 pts in subgroup (E) | Azacitidine | Seems not superior |
| Azacitidine & Lenalidomide | Not reported |
Chemotherapy
- Azacitidine (Vidaza) 75 mg/m2 SC/IV once per day on days 1 to 7
- Vorinostat (Zolinza) 300 mg PO BID on days 3 to 9
28-day cycles
Variant #2, 5-2-2 azacitidine
| Study | Evidence | Comparator | Efficacy |
|---|---|---|---|
| Sekeres et al. 2017 (SWOG S1117) | Randomized Phase II, <20 pts in subgroup (E) | Azacitidine | Seems not superior |
| Azacitidine & Lenalidomide | Not reported |
Chemotherapy
- Azacitidine (Vidaza) 75 mg/m2 SC/IV once per day on days 1 to 5, 8 & 9
- Vorinostat (Zolinza) 300 mg PO BID on days 3 to 9
28-day cycles
References
- SWOG S1117: Sekeres MA, Othus M, List AF, Odenike O, Stone RM, Gore SD, Litzow MR, Buckstein R, Fang M, Roulston D, Bloomfield CD, Moseley A, Nazha A, Zhang Y, Velasco MR, Gaur R, Atallah E, Attar EC, Cook EK, Cull AH, Rauh MJ, Appelbaum FR, Erba HP. Randomized phase II study of azacitidine alone or in combination with lenalidomide or with vorinostat in higher-risk myelodysplastic syndromes and chronic myelomonocytic leukemia: North American Intergroup Study SWOG S1117. J Clin Oncol. 2017 Aug 20;35(24):2745-2753. Epub 2017 May 9. link to original article contains verified protocol PubMed
Decitabine monotherapy
| back to top |
Regimen
| Study | Evidence | Efficacy |
|---|---|---|
| Santini et al. 2017 | Phase II | ORR: 48% |
Chemotherapy
- Decitabine (Dacogen) 20 mg/m2 IV once per day on days 1 to 5
28-day cycles
References
- Santini V, Allione B, Zini G, Gioia D, Lunghi M, Poloni A, Cilloni D, Sanna A, Masiera E, Ceccarelli M, Abdel-Wahab O, Terenzi A, Angelucci E, Finelli C, Onida F, Pelizzari A, Ferrero D, Saglio G, Figueroa M, Levis A. A phase II, multicentre trial of decitabine in higher-risk chronic myelomonocytic leukemia. Leukemia. 2018 Feb;32(2):413-418. Epub 2017 Jun 13. link to original article link to PMC article contains verified protocol PubMed
Maintenance after first-line therapy
Azacitidine monotherapy
| back to top |
Regimen
| Study | Evidence |
|---|---|
| Grövdal et al. 2010 | Phase II |
Chemotherapy
- Azacitidine (Vidaza) 60 mg/m2 SC once per day on days 1 to 5
28-day cycles
References
- Grövdal M, Karimi M, Khan R, Aggerholm A, Antunovic P, Astermark J, Bernell P, Engström LM, Kjeldsen L, Linder O, Nilsson L, Olsson A, Holm MS, Tangen JM, Wallvik J, Oberg G, Hokland P, Jacobsen SE, Porwit A, Hellström-Lindberg E. Maintenance treatment with azacytidine for patients with high-risk myelodysplastic syndromes (MDS) or acute myeloid leukaemia following MDS in complete remission after induction chemotherapy. Br J Haematol. 2010 Aug;150(3):293-302. Epub 2010 May 20. link to original article contains verified protocol PubMed content property of HemOnc.org