A Comparison of Hypomethylating Agents in CMML

A meta-analysis published in Hematology compared hypomethylating agents (HMAs) decitabine versus azaciticine in patients with chronic myelomonocytic leukemia (CMML).

The researchers queried PubMed, Medline, and Embase for relevant clinical trials or retrospective cohort studies published in English between January 1996 and March 2020 using key terms including “chronic myelomonocytic leukemia,” “deicitabine,” “azacitidine,” “myelodysplastic syndromes,” and “leukemia.” They also searched the references of eligible articles.

The meta-analysis comprised 14 studies encompassing a total of 600 patients with CMML who received decitabine (n=196) and azacitidine (n=404). The pooled overall response rate (ORR) estimate of the HMAs was 43% (95% confidence interval, 36-50%). ORRs were comparable for patients who received azacitidine or decitabine (43% vs. 45%; P=0.810). Patients who received decitabine had a higher marrow complete response than those who were given azacitidine (23% vs. 10%; P=0.000), as well as a higher incidence of transfusion independence (42% vs. 20%; P=0.044). Both groups of patients experienced objective hematologic or non-hematologic adverse events, with rates ranging from 27% to 43%. The azacitidine group had a higher rate of dosage modification/delay than the decitabine group (81% vs. 67%; P=0.021).

The study was limited by its lack of randomized, controlled trials, and the fact that only five of the 14 studies were phase II clinic studies, the researchers noted.

“As the there is no existing randomized controlled study reporting the efficacy of either HMA in a CMML cohort, this current systematic review and meta-analysis can only serve as a preliminary study in evaluating the efficacy and safety of HMAs in CMML,” the study authors concluded. “At last, we strongly recommend that randomized controlled trials of HMAs in cohort of patients with CMML to be hold in the future.”