Annals of Hematology

, Volume 98, Issue 8, pp 1919–1925 | Cite as

Identification of predictive factors for overall survival at baseline and during azacitidine treatment in high-risk myelodysplastic syndrome patients treated in the clinical practice

  • Emilia Scalzulli
  • Matteo Molica
  • Danilo Alunni Fegatelli
  • Gioia Colafigli
  • Lorenzo Rizzo
  • Marco Mancini
  • Fabio Efficace
  • Roberto Latagliata
  • Robin Foà
  • Massimo BrecciaEmail author
Original Article


The outcome of high-risk myelodysplastic syndrome (MDS) patients treated with 5-azacitidine (5-AZA) in the real-life setting remains largely unknown. We evaluated 110 MDS patients (IPSS intermediate 2/high) treated outside of clinical trials at a single institution between September 2003 and January 2017. Median duration of therapy was 9.5 cycles. The overall survival (OS) of the whole cohort was 66.1% at 1 year and 38.3% at 2 years. No differences in terms of OS were observed with regard to gender (p = 0.622) and age at baseline (< 65 years, 65–75, and > 75 years, p = 0.075). According to the IPSS-R, the very high-risk group had an inferior 2-year OS (17%) compared with intermediate-group patients (64%, p < 0.001). Transfusion independency at baseline was identified as a favorable prognostic factor on 1-year (66.8%) and 2-year OS (43.4%) (p < 0.001). After four cycles, the persistence of bone marrow blasts > 10% identified patients with a worse outcome, with a 2-year OS of 9.4% (p = 0.002). The occurrence of an infection during the first four cycles impacted on the 2-year OS (31.6% vs 58.3% in patients without infections, p = 0.032). Patients receiving at least 24 cycles of the drug have a 5-year OS of 38.2%. This analysis allowed to identify features at baseline or during treatment with 5-AZA associated with a different 2-year OS.


Azacitidine Hypomethylating agent Myelodysplastic syndromes Real-life 


Authors’ contributions

MB designed the study and wrote and revised the manuscript; ES wrote the manuscript; MM collected the data; DAF and FE analyzed the data; LR, RL, GC, and MMa followed the patients; RF critically revised the paper and approved the final version.

Compliance with ethical standards

Conflict of interest

MB received honoraria by Novartis, Pfizer, and Incyte; FE received personal fees from Bristol Myers Squibb, Incyte, Orsenyx, and Amgen. All other authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

277_2019_3724_MOESM1_ESM.docx (693 kb)
ESM 1 (DOCX 692 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Emilia Scalzulli
    • 1
  • Matteo Molica
    • 1
  • Danilo Alunni Fegatelli
    • 2
  • Gioia Colafigli
    • 1
  • Lorenzo Rizzo
    • 1
  • Marco Mancini
    • 1
  • Fabio Efficace
    • 3
  • Roberto Latagliata
    • 1
  • Robin Foà
    • 1
  • Massimo Breccia
    • 1
    Email author
  1. 1.Hematology, Department of Precision and Translational Medicine, Azienda Ospedaliera Policlinico Umberto ISapienza UniversityRomeItaly
  2. 2.Department of Statistical SciencesSapienza UniversityRomeItaly
  3. 3.Data Center and Health Outcomes Research UnitItalian Group for Adult Hematologic Diseases (GIMEMA)RomeItaly

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