Decitabine and Azacitidine in the Treatment of Chronic Myelomonocytic Leukemia

By Patrick Daly - Last Updated: November 29, 2021

Researchers performed a meta-analysis to evaluate two hypomethylating agents (HMAs), decitabine and azacitidine, in the treatment of patients with chronic myelomonocytic leukemia (CMML). Their report, published in Hematology, suggested that decitabine and azaciticine are relatively similar in terms of safety and efficacy.

According to the study’s lead author, Ruohao Xu, and his colleagues, “[the] current study may provide preliminary data in evaluating the efficacy and safety of HMAs in patients with CMML. However, it is necessary to point out that any comparison of decitabine and azacitidine with respect to clinical outcomes can only be done in the context of a randomized controlled trial.”

Researchers analyzed 14 studies with 600 CMML patients treated with decitabine (n=196) or azacytidine (n=404). They calculated pooled estimates of patients’ response to hypomethylating agents and drug-related adverse events using a fixed or random effect model.

The authors reported a pooled overall response rate (ORR) estimate of 43% (95% confidence interval [CI], 36%–50%) for HMAs in patients with CMML. Both azacitidine and decitabine exhibited comparable incidences of ORR (43% vs. 45%, p = 0.810). Notably however, the researchers observed a significantly higher incidence of marrow complete response (mCR) in patients treated with decitabine (23% vs. 10%, p = 0.000).

They also associated decitabine with a higher percentage of patients who achieved transfusion independence (42% vs. 20%, p = 0.044). Azacitidine treatment had more frequent dosage modifications/delays (81% vs. 67%, p = 0.021). Both HMAs led to objective hematologic or non-hematologic adverse events (27%–43%).

The study’s results showed that decitabine and azacitidine are comparatively safe and effective, with decitabine appearing to show certain advantages. The study’s authors noted that comparing clinical outcomes between the two drugs would require randomized and controlled trials.