Hypomethylating agent versus hydroxyurea

In a prospective randomized trial, 170 patients with newly diagnosed advanced CMML received intravenous decitabine or hydroxyurea (1–4 g/day). With a median follow-up of 17.5 months, there was no statistically significant difference in event-free survival (12.1 months for patients who received decitabine and 10.3 months for patients who received hydroxyurea; hazard ratio, 0.83; 95% confidence interval [CI], 0.59–1.16; P = .27). There was also no statistically significant difference in median OS (16.3 months for patients who received decitabine and 21.9 months for patients who received hydroxyurea; P = .67).[39][Level of evidence A1] Although decitabine reduced CMML progression or transformation to AML by 38% compared with hydroxyurea, this was offset by a 55% increase in deaths that were not caused by progression (the deaths were usually related to infection). There are no data to suggest that systematic antibiotic prophylaxis would have helped the patients who received decitabine.