Background: AML is an aggressive haematological malignancy. Although advanced strategies we have reached for acute myeloid leukemia treatment to achieve complete remission, relapse is still common and overall survival is very poor specially in elderly patients. That leads to the need for using maintenance therapy that can help in delaying relapse and prolonging survival rate. DNA hypomethylating agents azaictidine and decitabine have been used and had a good promising result on this group of patients but no direct clinical trials performed to compare the two agents. In this systematic review we reviewed the literature for comparison between hypomethylating agents as maintenance therapy in elderly AML patients.
Aim of the Work: Perform a systematic review to assess the efficacy and safety of different hypomethylating agents (Azacitidine and Decitabine) as maintenance therapy for acute myeloid leukemia in elderly patients.
Methodology: In this systematic review, we searched Medline via PubMed, Web of Science, and CENTRAL from their inception till April 2021. A total of 296 records were obtained. After screening, 9 randomized controlled trials including 1046 patients were included.
Results: Our results showed that, treating patients with azacitidine or decitabine as maintenance therapy provided improved outcomes in terms of overall survival, disease free survival, relapse compared to placebo or supportive care. Direct comparison showed that azacitidne was superior to decitabine in terms of relapse and remission. However, there was no significant results in other outcomes.
Conclusion: Compared to standard supportive care or placebo, azacitidine or decitabine as maintenance therapy yields both better outcomes, including overall survival, disease free survival, relapse and remission. However, azacitidne was superior to deciatabine in delaying relapse. Although, indirect head-to-head comparisons, low certainty of evidence was found when comparing azacytidine and decitabine for other outcomes. The superiority of either agent cannot be confirmed in this study except in relapse rate and head-to-head clinical trials are still required to provide more information about the efficacy and safety of the two agents.