ISSN 2997-1036
International Journal of Hematology | Vol. 12, No. 11, November 2021 | pp. 81–88
DOI: 10.46882/2021/IJH/000141
Original Article
Title: Clinical features and response kinetics of low-dose azacitidine combined with low-dose cytarabine in elderly patients with myelodysplastic syndromes
Names of Authors: A. I. Ibrahim¹, C. D. Balogun², E. O. Ojo³
Authors’ Affiliations: ¹Department of Haematology, Ahmadu Bello University, Zaria, Nigeria; ²Department of Medicine, University of Ilorin, Ilorin, Nigeria; ³Department of Chemical Pathology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
Abstract: High-risk myelodysplastic syndromes in frail elderly patients carry poor prognoses and limited therapeutic options due to intensive treatment toxicities. This prospective study evaluated the safety and clinical response kinetics of a low-dose combination protocol comprising subcutaneous azacitidine (50 mg/m² daily for 5 days) and low-dose cytarabine (10 mg daily for 10 days) in 24 elderly individuals (aged ≥ 70 years) categorized with advanced myelodysplastic variants. Full blood counts, bone marrow cytopenias, and blast percentages were assessed at baseline and every two treatment cycles. Hematological improvement or partial marrow remission was documented in 62.5% (15 of 24) of the patients within a median of three cycles. The mean hemoglobin level rose from 6.8 ± 1.1 g/dl to 10.4 ± 1.2 g/dl by month 6 (P < 0.01), eliminating red blood cell transfusion dependency in 53.3% of responsive individuals. Grade 3 neutropenia occurred in 20.8% of cases but was successfully managed with transient growth factor support without dropping therapy. This low-dose epigenetic combination provides satisfactory disease control, low myelosuppressive profiles, and structural cost-effectiveness, offering an excellent alternative for vulnerable elderly cohorts.
Keywords: Myelodysplastic syndromes, azacitidine, cytarabine, elderly patients, hematological improvement
Manuscript Timeline: Received: August 14, 2021; Revised: September 20, 2021; Accepted: October 12, 2021; Published: November 15, 2021