A comparison of overall survival and quality of life in patients with MDS treated with azacytidine vs decitabine
Year: 2026
Type: article
Study design: Observational Study
Abstract: : Patients with higher-risk MDS are considered for therapy with hypomethylating agents (HMAs), to help restore hematopoiesis, delay progression to AML, and improve overall-survival (OS). Azacytidine (AZA) and decitabine (DEC) have commonly been used without direct clinical trial comparison between these agents. Prior studies have observed no difference in OS; but these analyses are limited by the lack of patient-level and disease risk factors that may influence efficacy and tolerability. The current study retrospectively evaluated the differences in clinical outcomes for patients treated with AZA or DEC adjusted for disease risk-category and patient-specific factors using data from the Canadian MDS Registry (MDS-CAN; NCT02537990). The primary outcome was OS and was compared with log-rank test; evaluated for the whole cohort and then stratified by IPSS-R disease risk. Secondary outcomes included Leukemia-Free Survival (LFS), change in transfusion dependence (TD)/independence (TI) status, and differences in QoL measurements. In total 424 patients were treated with AZA (median of 10 cycles) and 85 with DEC (median of 5 cycles). In unadjusted analysis, median OS was longer in the DEC-treated patients (37.0 vs. 21.4 months, p=0.001) which remained significant for higher-risk patients defined by IPSS-R score >3.5 (34.4 vs. 19.6 months, P=0.01). 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.
Source: Blood Neoplasia
Authors: James T. England, Liying Zhang, Karen Yee, Michelle Geddes, Nancy Zhu, April Shamy, Heather Leitch, Mitchell Sabloff, Grace Christou, Brett L. Houston, Ivan Landego, Brian Leber, Dina Khalaf, Alejandro Garcia-Horton, Eve St-Hilaire, Nicholas Finn, Thomas Nevill, Amy Trottier, John Storring, Mohamed Elemary, Robert Delage, Laura Habib, Lisa Chodirker, Signy Chow, Matthew Cheung, Lee Mozessohn, James A. Kennedy, Rena Buckstein
Institutions: Sunnybrook Health Science Centre, Princess Margaret Cancer Centre, Alberta Hospital Edmonton, University of Alberta Hospital, Jewish General Hospital, St. Paul's Hospital, Ottawa Hospital, Juravinski Cancer Centre, University of Manitoba, University of Florida Health, University of Florida, Dr. Georges-L.-Dumont University Hospital Centre, Vancouver General Hospital, Dalhousie University, McGill University, Saskatoon Cancer Centre, Hôpital de l'Enfant-Jésus
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,000
OpenAlex ID: W7204214328