A comparison of overall survival and quality of life in patients with MDS treated with azacytidine vs decitabine.
16 affiliations
- 1Sunnybrook Health Sciences Centre, Toronto, Canada.
- 2Princess Margaret Cancer Centre, Toronto, Canada.
- 3Tom Baker Cancer Center, Calgary, Canada.
- 4University of Alberta Hospital, Edmonton, Canada.
- 5Jewish General Hospital, Montreal, Canada.
- 6St. Paul's Hospital, Vancouver, Canada.
- 7The Ottawa Hospital, Ottawa, Canada.
- 8Juravinski Cancer Centre, Hamilton, Canada.
- 9Division of Medical Oncology and Hematology, University of Manitoba, Winnipeg, Canada.
- 10Division of Medical Oncology and Hematology, University of Florida, Gainesville, FL.
- 11Centre Hospitalier Universitaire Dr-Georges-L.-Dumont, Moncton, Canada.
- 12Vancouver General Hospital, Vancouver, Canada.
- 13Division of Hematology, Dalhousie University, Halifax, Canada.
- 14Division of Hematology, McGill University, Montreal, Canada.
- 15Saskatchewan Cancer Centre, Saskatoon, Canada.
- 16Hôpital de l'Enfant-Jésus, Laval, Canada.
Abstract
Patients with high-risk myelodysplastic neoplasms or syndromes (MDS) are considered for therapy with hypomethylating agents (HMA) to help restore hematopoiesis, delay progression to acute myeloid leukemia, and improve overall survival (OS). Azacytidine (AZA) and decitabine (DEC) have commonly been used without direct clinical trial comparison between the 2 agents. Prior studies have demonstrated no difference in OS; however, these analyses are limited by the lack of patient-level and disease-risk factors that may influence efficacy and tolerability. This study retrospectively evaluated differences in clinical outcomes for patients treated with AZA or DEC, adjusting for disease-risk category and patient-specific factors, using data from the Canadian MDS registry (NCT02537990). The primary outcome for the study was OS, which was compared using the log-rank test, evaluated for the whole cohort, and then stratified by the Revised International Prognostic Scoring System (IPSS-R) disease-risk. Secondary outcomes included leukemia-free survival (LFS), change in transfusion dependence or independence status, and differences in quality-of-life (QoL) measurements. In total, 424 patients were treated with AZA (median of 10 cycles) and 85 patients were treated with DEC (median of 5 cycles). In unadjusted analysis, median OS was longer in the patients treated with DEC (37.0 vs 21.4 months; P = .001), which remained significant for patients with high-risk defined by an IPSS-R score >3.5 (34.4 vs 19.6 months; P = .01). However, in a propensity score-matched analysis, there was no difference in OS or LFS between HMA therapies. There was no significant difference in global, physical, or social QoL scores between patients treated with either HMA.
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BibTeX
@article{england2026comparison,
title = {{A comparison of overall survival and quality of life in patients with MDS treated with azacytidine vs decitabine.}},
author = {James T England and Liying Zhang and Karen Yee and Michelle Geddes and Nancy Zhu and April Shamy and Heather Leitch and Mitchell Sabloff and Grace Christou and Brett L Houston and Ivan Landego and Brian Leber and Dina Khalaf and Alejandro Garcia-Horton and Eve St-Hilaire and Nicholas Finn and Thomas Nevill and Amy Trottier and John Storring and Mohamed Elemary and Robert Delage and Laura Habib and Lisa Chodirker and Signy Chow and Matthew Cheung and Lee Mozessohn and James A Kennedy and Rena Buckstein},
journal = {Blood neoplasia},
year = {2026},
month = aug,
doi = {10.1016/j.bneo.2026.100293},
url = {https://europepmc.org/article/MED/42903632},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - A comparison of overall survival and quality of life in patients with MDS treated with azacytidine vs decitabine.
AU - James T England
AU - Liying Zhang
AU - Karen Yee
AU - Michelle Geddes
AU - Nancy Zhu
AU - April Shamy
AU - Heather Leitch
AU - Mitchell Sabloff
AU - Grace Christou
AU - Brett L Houston
AU - Ivan Landego
AU - Brian Leber
AU - Dina Khalaf
AU - Alejandro Garcia-Horton
AU - Eve St-Hilaire
AU - Nicholas Finn
AU - Thomas Nevill
AU - Amy Trottier
AU - John Storring
AU - Mohamed Elemary
AU - Robert Delage
AU - Laura Habib
AU - Lisa Chodirker
AU - Signy Chow
AU - Matthew Cheung
AU - Lee Mozessohn
AU - James A Kennedy
AU - Rena Buckstein
PY - 2026
DA - 2026/08/25
JO - Blood neoplasia
DO - 10.1016/j.bneo.2026.100293
UR - https://europepmc.org/article/MED/42903632
AB - Patients with high-risk myelodysplastic neoplasms or syndromes (MDS) are considered for therapy with hypomethylating agents (HMA) to help restore hematopoiesis, delay progression to acute myeloid leukemia, and improve overall survival (OS). Azacytidine (AZA) and decitabine (DEC) have commonly been used without direct clinical trial comparison between the 2 agents. Prior studies have demonstrated no difference in OS; however, these analyses are limited by the lack of patient-level and disease-risk factors that may influence efficacy and tolerability. This study retrospectively evaluated differences in clinical outcomes for patients treated with AZA or DEC, adjusting for disease-risk category and patient-specific factors, using data from the Canadian MDS registry (NCT02537990). The primary outcome for the study was OS, which was compared using the log-rank test, evaluated for the whole cohort, and then stratified by the Revised International Prognostic Scoring System (IPSS-R) disease-risk. Secondary outcomes included leukemia-free survival (LFS), change in transfusion dependence or independence status, and differences in quality-of-life (QoL) measurements. In total, 424 patients were treated with AZA (median of 10 cycles) and 85 patients were treated with DEC (median of 5 cycles). In unadjusted analysis, median OS was longer in the patients treated with DEC (37.0 vs 21.4 months; P = .001), which remained significant for patients with high-risk defined by an IPSS-R score >3.5 (34.4 vs 19.6 months; P = .01). However, in a propensity score-matched analysis, there was no difference in OS or LFS between HMA therapies. There was no significant difference in global, physical, or social QoL scores between patients treated with either HMA.
SN - 2950-3280
ER -