***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Background Allogeneic stem-cell transplantation ( HSCT ) is the only curative treatment in myelodysplastic syndromes ( MDS ) . Azacitidine ( AZA ) is increasingly used prior to HSCT , however in Europe it is only approved for patients who are not eligible for HSCT . Patients and methods We conducted a phase II multicenter study to prospect ively evaluate the feasibility of HSCT after treatment with AZA in 70 patients with a myelodysplastic syndrome ( MDS ) , 19 with acute myeloid leukemia ( AML ) , and 8 with chronic myelomonocytic leukemia ( CMML ) . After a median of four cycles ( range 1 - 11 ) : 24 % of patients achieved complete remission , 14 % partial remission , 8 % hematologic improvement , 32 % had stable and 22 % progressive disease . Ten patients discontinued treatment before the planned four cycles , due to an adverse event in nine cases . Results A HSC donor was identified in 73 patients , and HSCT was performed in 54 patients ( 74 % of patients with a donor ) . Main reasons for turning down HSCT were lack of a donor , an adverse event , or progressive disease ( 9 , 12 , and 16 patients , respectively ) . At a median follow-up of 20.5 months from enrolment , response to AZA was the only independent prognostic factor for survival . Compared to baseline assessment , AZA treatment did not affect patients ' comorbidities at HSCT : the HCT-CI remained stable in 62 % patients , and worsened or improved in 23 % and 15 % of patients , respectively . Conclusions Our study shows that HSCT is feasible in the majority of patients with HR-MDS/AML/CMML-2 after AZA treatment . As matched unrelated donor was the most frequent source of donor cells , the time between diagnosis and HSCT needed for donor search could be ' bridged ' using azacitidine . These data show that AZA prior to HSCT could be a better option than intensive chemotherapy in higher-risk MDS . The trial has been registered with the EudraCT number 2010 - 019673 - 1 Cytoreduction before allogeneic stem cell transplantation ( allo-SCT ) for patients with myelodysplastic syndromes remains a debatable issue . After excluding patients who had received preconditioning induction chemotherapy , we analyzed 128 consecutive patients with myelodysplastic syndrome who received reduced-intensity or nonmyeloablative conditioning ( RIC/NMA ) allo-SCT .  Among them , 40 received azacitidine ( AZA ) before transplant ( AZA group ) and 88 were transplanted up front ( best supportive care [ BSC ] group ) . At diagnosis , 55 patients had intermediate 2 or high-risk scores per the International Prognostic Scoring System and 33 had a high cytogenetic risk score . Progression to a more advanced disease before allo-SCT was recorded in 22 patients . Source of stem cells were blood ( n = 112 ) or marrow ( n = 16 ) from sibling ( n = 78 ) or HLA-matched unrelated ( n = 50 ) donors . With a median follow-up of 60 months , 3-year overall survival , relapse-free survival , cumulative incidence of relapse , and nonrelapse mortality were , respectively , 53 % versus 53 % ( P = .69 ) , 37 % versus 42 % ( P = .78 ) , 35 % versus 36 % ( P = .99 ) , and 20 % versus 23 % ( P = .74 ) , for the AZA group and BSC group , respectively . Multivariate analysis confirmed the absence of statistical differences in outcome between the AZA and BSC groups , after adjusting for potential confounders using the propensity score approach . The absence of cytoreduction before RIC/NMA allo-SCT did not seem to alter the outcome . However , our results emphasize the need to perform prospect i ve protocol s to delineate the role of debulking strategy and to identify subsets of patients who may benefit from this approach This analysis compared azacitidine ( AZA ) to conventional care regimens ( CCR ) and their associated overall survival ( OS ) and tolerability in the subset of 87 elderly ( ≥ 75 years ) patients with higher-risk MDS ( FAB : RAEB , RAEB-t , CMML and IPSS : Int-2 or High ) from the AZA-001 trial . Patients were r and omized to AZA ( 75 mg/m(2)/daysubcutaneously × 7 days every 28 days ) ( n=38 ) or CCR ( n=49 ) and had median ages of 78 and 77 years , respectively . AZA significantly improved OS vs CCR ( HR : 0.48 [ 95%CI : 0.26 , 0.89 ] ; p=0.0193 ) and 2-year OS rates were 55 % vs 15 % ( p<0.001 ) , respectively . AZA was generally well tolerated compared with CCR , which was primarily best supportive care ( 67 % ) . Grade 3 - 4 anemia , neutropenia , and thrombocytopenia with AZA vs CCR were 13 % vs 4 % , 61 % vs 17 % , and 50 % vs 30 % , respectively . Given this efficacy and tolerability , AZA should be considered the treatment of choice in patients aged ≥ 75 years with good performance status and higher-risk MDS Aberrant DNA methylation , which results in leukemogenesis , is frequent in patients with myelodysplastic syndromes ( MDS ) and is a potential target for pharmacologic therapy . Decitabine indirectly depletes methylcytosine and causes hypomethylation of target gene promoters In a study of elderly AML patients treated with the hypomethylating agent decitabine ( DAC )  , we noted a surprisingly favorable outcome in the ( usually very unfavorable ) subgroup with two or more autosomal monosomies ( MK2 + ) within a complex karyotype ( Lübbert et al. , Haematologica 97:393 - 401 , 2012 ) . We now analyzed 206 myelodysplastic syndrome ( MDS ) patients ( 88 % of 233 patients r and omized in the EORTC/GMDSSG phase III trial 06011 , 61 of them with RAEBt , i.e. AML by WHO ) with cytogenetics informative for MK status .. Endpoints are the following : complete/partial ( CR/PR ) and overall response rate ( ORR ) and progression-free ( PFS ) and overall survival ( OS ) . Cytogenetic subgroups are the following : 63 cytogenetically normal ( CN ) patients , 143 with cytogenetic abnormalities , 73 of them MK-negative ( MK− ) , and 70 MK-positive ( MK+ ) . These MK+ patients could be divided into 17 with a single autosomal monosomy ( MK1 ) and 53 with at least two monosomies ( MK2 + ) . ORR  with DAC in CN patients : 36.1 % , in MK− patients : 16.7 % , in MK+ patients : 43.6 % ( MK1 : 44.4 % , MK2 + 43.3 % ) . PFS was prolonged by DAC compared to best supportive care ( BSC ) in the CN ( hazard ratio ( HR ) 0.55 , 99 % confidence interval ( CI ) , 0.26 ; 1.15 , p = 0.03 ) and MK2 + ( HR 0.50 ; 99 % CI , 0.23 ; 1.06 , p = 0.016 ) but not in the MK− , MK+ , and MK1 subgroups . OS was not improved by DAC in any subgroup . In conclusion , we demonstrate for the first time in a r and omized phase III trial that high-risk MDS patients with complex karyotypes harboring two or more autosomal monosomies attain encouraging responses and have improved PFS  with DAC treatment compared to BSC Background Few studies thus far have compared head-to-head different non-myelooablative conditioning regimens for allogeneic hematopoietic cell transplantation ( allo-HCT ) . Methods Here , we report the results of a phase II multicenter r and omized study comparing  non-myeloablative allo-HCT from HLA-identical siblings ( n = 54 ) or from 10/10 HLA-matched unrelated donors ( n = 40 ) with either fludarabine plus 2 Gy total body irradiation ( Flu-TBI arm ; n = 49 ) or 8 Gy TLI + anti-thymocyte globulin ( TLI-ATG arm ; n = 45 ) conditioning . Results The 180-day cumulative incidences of grade II-IV acute GVHD ( primary endpoint ) were 12.2 % versus 8.9 % in Flu-TBI and TLI-ATG patients , respectively ( P = 0.5 ) . Two-year cumulative incidences of moderate/severe chronic GVHD were 40.8 % versus 17.8 % in Flu-TBI and TLI-ATG patients , respectively ( P = 0.017 ) . Five Flu-TBI patients and 10 TLI-ATG patients received pre-emptive DLI for low donor chimerism levels , while 1 Flu-TBI patient and 5 TLI-ATG patients ( including 2 patients given prior pre-emptive DLIs ) received a second HCT for poor graft function , graft rejection , or disease progression . Four-year cumulative incidences of relapse/progression were 22 % and 50 % in Flu-TBI and TLI-ATG patients , respectively ( P = 0.017 ) . Four-year cumulative incidences of nonrelapse mortality were 24 % and 13 % in Flu-TBI and TLI-ATG patients , respectively ( P = 0.5 ) . Finally , 4-year overall ( OS ) and progression-free survivals ( PFS ) were 53 % and 54 % , respectively , in the Flu-TBI arm , versus 54 % ( P = 0.9 ) and 37 % ( P = 0.12 ) , respectively , in the TLI-ATG arm . Conclusions In comparison to patients included in the Flu-TBI arm , patients included in the TLI-ATG arm had lower incidence of chronic GVHD , higher incidence of relapse and similar OS.Trial registration The study was registered on Clinical Trial.gov ( NCT00603954 ) and EUDRACT ( 2010 - 024297 - 19 ) Background The treatment of acute myeloid leukemia of older , medically non-fit patients still poses a highly unmet clinical need , and only few large , prospect i ve studies have been performed in this setting . Given the established activity of hypomethylating agents such as 5-aza-2'-deoxycytidine ( decitabine ) in myelodysplastic syndromes and acute myeloid leukemia with 20–30 % bone marrow blasts , we investigated whether this drug is also active in patients with more than 30 % blasts . Design and Methods To evaluate the efficacy and toxicity of decitabine in patients over 60 years old with untreated acute myeloid leukemia ineligible for induction chemotherapy , 227 patients ( median age , 72 years ) , many with comorbidities , adverse cytogenetics and /or preceding myelodysplastic syndrome were treated with this hypomethylating agent . During the initial decitabine treatment ( 135 mg/m2 total dose infused intravenously over 72 hours every 6 weeks ) , a median of two cycles was administered ( range , 1–4 ) . All-trans retinoic acid was administered to 100 patients during course 2 . Fifty-two patients who completed four cycles of treatment subsequently received a median of five maintenance courses ( range , 1–19 ) with a lower dose of decitabine ( 20 mg/m2 ) infused over 1 hour on 3 consecutive days every 4–6 weeks . Results The complete and partial remission rate was 26 % , 95 % CI ( 20 % , 32 % ) , and an antileukemic effect was noted in 26 % of patients . Response rates did not differ between patients with or without adverse cytogenetics ; patients with monosomal karyotypes also responded . The median overall survival from the start of decitabine treatment was 5.5 months ( range , 0–57.5 + ) and the 1-year survival rate was 28 % , 95%CI ( 22%,34 % ) . Toxicities were predominantly hematologic . Conclusions Decitabine is well tolerated by older , medically non-fit patients with acute myeloid leukemia ;  myelosuppression is the major toxicity . The response rate and overall survival were not adversely influenced by poor-risk cytogenetics or myelodysplastic syndrome . Because of these encouraging results , r and omized studies evaluating single-agent decitabine versus conventional treatment are warranted . The study is registered with the German Clinical Trials Registry , number DRKS00000069 BACKGROUND The molecular determinants of clinical responses to decitabine therapy in patients with acute myeloid leukemia ( AML ) or myelodysplastic syndromes ( M 
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No evidence showed that patients with MDS will benefit from using HMAs  before HSCT in long-term survival ( OS and RFS ) compared to chemotherapy or best supportive therapy , though older patients were more likely to benefit from pre-transplantation HMAs treatment in terms of long-term survival .