Monitoring treatment with 5-Azacitidine by flow cytometry predicts duration of hematological response in patients with myelodysplastic syndrome

Dolores Subirá*, Canan Alhan, Uta Oelschlaegel, Anna Porwit, Katherina Psarra, Theresia M. Westers, Nuria Golbano, Lars Nilsson, Arjan A. van de Loosdrecht, Dunia de Miguel

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


5-Azacitidine (AZA) therapy is used in high-risk myelodysplastic syndrome (MDS) patients who often show abnormalities in their immunophenotype. We explored the potential impact of AZA on these immunophenotypic abnormalities in serial bone marrow studies performed in 81 patients from five centers. We compared the immunophenotypic features before and after therapy with AZA, established definitions consistent with flow cytometry immunophenotyping (FCI) improvement, and explored its clinical significance. After a median of 6 cycles of AZA, 41% of patients showed a FCI improvement and this finding associated with best possible clinical response (P < 0.001). FCI improvement also correlated with hematological improvement (HI) (53/78 patients; 68%), independently of their eligibility for stem cell transplantation. Among patients who achieved a HI after 6 cycles of AZA, the probability of maintaining this response at 12 cycles of AZA was twice as large (67%) for those patients who also achieved a FCI improvement after 6 cycles of AZA as compared to patients who did not (33%, P < 0.01). These findings support that monitoring of the immunophenotypic abnormalities during therapy with AZA may assist in redefining the quality of response in patients with MDS.

Original languageEnglish
Pages (from-to)1711-1722
Number of pages12
JournalAnnals of Hematology
Issue number7
Early online date2021
Publication statusPublished - Jul 2021

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