Phase-II Trial to Assess the Efficacy and Toxicity of 5-Azacitidine in Addition to Standard DLI for the Treatment of Patients With AML or MDS Relapsing After Allogeneic Stem Cell Transplantation
Relapse after allogeneic stem cell transplantation is a major problem in patients with poor
prognosis AML or MDS. Donor lymphocyte infusions alone re-induce remission in a minority of
these patients, which may be the result of poor differentiation of the leukemic cells. The
study drug 5-Aza is effective in AML and MDS.In addition to direct cytotoxicity, it
alters gene expression and induces differentiation of leukemic blast cells.
Furthermore, DNA-demethylating treatment results in an induction of transcription
and cell surface expression of formerly unexpressed KIRs (killer Ig-like receptors) in NK
cells, which are involved in the specific recognition of leukemic target cells and who are
able to generate a specific graft-versus leukemia effect. The increased expression of MHC
class I and II molecules on the surface of the recipient's leukemic cells and the de novo
expression of formerly silenced KIR genes in donor NK cells due to treatment with 5-Aza may
result in an increased susceptibility of myeloid leukemic cells to the allogeneic graft
versus leukemia effect. Therefore, the graft-versus leukemia effect by donor lymphocyte
infusions and NK cells from the original donor may be supported by additional therapy with
5-Azacitidine.
Interventional
Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Best response
within the 6 months of treatment
No
Guido Kobbe, PD Dr.
Principal Investigator
Department of Hematology, Oncology and Clinical Immunology
Germany: Federal Institute for Drugs and Medical Devices
AZARELA_HHU_2007
NCT00795548
November 2008
August 2011
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