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Comparison between decitabine and azacitidine for the treatment of myelodysplastic syndrome: a meta-analysis with 1392 participants

The hypomethylating agents decitabine and azacitidine have been found to improve the outcome of patients with myelodysplastic syndrome (MDS); however, the clinical choice between them is controversial. Therefore, this meta-analysis was performed to compare the efficacy, toxicity, and survival advantage of decitabine and azacitidine in patients with MDS. Eleven trials with a total of 1392 patients with MDS (decitabine, n = 768; azacitidine, n = 624) were included for analysis. The pooled estimates of partial response, hematologic improvement, and overall response rates for azacitidine were significantly higher than for decitabine. There were no differences between these 2 drugs regarding complete response, red blood cell transfusion-independent rates, and grade 3 or 4 hematologic toxicity. When compared with best supportive care, azacitidine significantly improved overall survival (hazard ratio [HR], 0.69; 95% CI, 0.54-0.87) and time to acute myeloid leukemia transformation (HR, 0.51; 95% CI, 0.35-0.74). But these benefits were not found with decitabine. Among patients with higher risk (International Prognostic Scoring System value of 3) or older than 75 years, treatment with azacitidine was a favorable factor, whereas decitabine showed no advantage. Therefore, with higher overall response rates and better survival benefits, azacitidine is recommended as the first-line hypomethylating agent for MDS, especially in elderly patients or those with high risk.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Addendum to Haematological Cancers: Improving Outcomes (Update)

Different levels of service are needed to manage haematological cancers, depending on the particular cancer in question. Because of the increased complexity of care and changes in the levels of care from those specified in the 2003 NICE cancer service guidance on improving outcomes in haematological cancers, an update was needed.

NICE Guideline - National Collaborating Centre for Cancer (UK).

Version: May 2016
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Dasatinib and Nilotinib for Imatinib-Resistant or -Intolerant Chronic Myeloid Leukaemia: A Systematic Review and Economic Evaluation

Chronic myeloid leukaemia (CML) is a form of cancer affecting the blood, characterised by excessive proliferation of white blood cells in the bone marrow and circulating blood. In the UK, an estimated 560 new cases of CML are diagnosed each year.

Health Technology Assessment - NIHR Journals Library.

Version: April 2012
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Myelodysplastic Syndromes Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of myelodysplastic syndromes (MDS).

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 2, 2015

Adult Acute Myeloid Leukemia Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of adult acute myeloid leukemia.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: January 15, 2016

Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of childhood acute myeloid leukemia, myelodysplastic syndromes, and other myeloproliferative disorders.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: December 1, 2016

5-azacitidine prolongs overall survival in patients with myelodysplastic syndrome: a systematic review and meta-analysis

This well-conducted review found that hypomethylating agents, particularly 5-azacitidine, improved survival and other outcomes compared with conventional care, but were associated with significant adverse events. These conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Systematic Reviews in PubMed

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