Difference between revisions of "Chronic myelomonocytic leukemia"
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Revision as of 14:31, 25 January 2020
Section editor | |
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Sanjay R. Mohan, MD, MSCI Vanderbilt University Nashville, TN |
7 regimens on this page
10 variants on this page
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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
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Regimen variant #1, 7 days
Study | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|
Sekeres et al. 2017 (SWOG S1117) | Randomized Phase II, <20 pts in subgroup (C) | 1. Azacitidine & Lenalidomide | Seems not superior |
2. Azacitidine & Vorinostat | Seems not superior |
Chemotherapy
- Azacitidine (Vidaza) 75 mg/m2 IV or SC once per day on days 1 to 7
28-day cycles
Regimen variant #2, 5-2-2
Study | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|
Drummond et al. 2014 | Phase II | ||
Sekeres et al. 2017 (SWOG S1117) | Randomized Phase II, <20 pts in subgroup (C) | 1. Azacitidine & Lenalidomide | Seems not superior |
2. 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
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
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Regimen variant #1, 7 days of azacitidine
Study | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|
Sekeres et al. 2017 (SWOG S1117) | Randomized Phase II, <20 pts in subgroup (E-esc) | 1. Azacitidine | Seems not superior |
2. Azacitidine & Vorinostat | Not reported |
Chemotherapy
- Azacitidine (Vidaza) 75 mg/m2 IV or SC once per day on days 1 to 7
- Lenalidomide (Revlimid) 10 mg PO once per day on days 1 to 21
28-day cycles
Regimen variant #2, 5-2-2 azacitidine
Study | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|
Sekeres et al. 2017 (SWOG S1117) | Randomized Phase II, <20 pts in subgroup (E-esc) | 1. Azacitidine | Seems not superior |
2. Azacitidine & Vorinostat | Not reported |
Chemotherapy
- Azacitidine (Vidaza) 75 mg/m2 IV or SC 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 |
Regimen variant #1, 7 days of azacitidine
Study | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|
Sekeres et al. 2017 (SWOG S1117) | Randomized Phase II, <20 pts in subgroup (E-esc) | 1. Azacitidine | Seems not superior |
2. Azacitidine & Lenalidomide | Not reported |
Chemotherapy
- Azacitidine (Vidaza) 75 mg/m2 IV or SC once per day on days 1 to 7
- Vorinostat (Zolinza) 300 mg PO twice per day on days 3 to 9
28-day cycles
Regimen variant #2, 5-2-2 azacitidine
Study | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|
Sekeres et al. 2017 (SWOG S1117) | Randomized Phase II, <20 pts in subgroup (E-esc) | 1. Azacitidine | Seems not superior |
2. Azacitidine & Lenalidomide | Not reported |
Chemotherapy
- Azacitidine (Vidaza) 75 mg/m2 IV or SC once per day on days 1 to 5, 8 & 9
- Vorinostat (Zolinza) 300 mg PO twice per day 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
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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
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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