University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
Carl Zainaldin , Sankalp Arora , Sri Bathini , Vishruti Pandya , Sejong Bae , Udita Gupta , Sarah Worth` , Kimo Bachiashvili , Ravi Bhatia , Kelly Nicole Godby , Omer Jamy , Sravanti Rangaraju , Barry Diamond , Josh D Oliver , Donna E. Salzman , Antonio Di Stasi , Pankit Vachhani
Background: Venetoclax in combination with hypomethylating agents (HMA+Ven) is the standard-of-care treatment for patients with newly diagnosed acute myeloid leukemia (AML) who are ineligible for intensive chemotherapy. HMA+Ven is also commonly used as salvage therapy for relapsed or refractory (R/R) AML. There is limited data regarding outcomes of AML patients after HMA+Ven failure. In clinical practice, survival following HMA+Ven failure, either as frontline or salvage therapy, is observed to be poor. Methods: We conducted a single center retrospective study to evaluate survival outcomes of AML patients who were R/R to HMA+Ven as frontline or salvage therapy. Patients ≥ 18 years of age with AML who initiated HMA+Ven between 06/2018 and 05/2021 were included. R/R AML was defined as clinically relevant disease with ≥ 5% blasts after prior complete remission/morphologic leukemia free state, refractoriness to at least two cycles of HMA+Ven, or progressive disease despite initiating HMA+Ven. Data cut-off was 02/07/2022. Overall survival (OS) was estimated using Kaplan-Meier method and outcome differences between sub-groups were assessed using the log rank test. Results: Forty-two patients met inclusion criteria. Baseline characteristics and treatment details are summarized in Table. The median OS of the overall cohort was 2.3 months (range 0.1-11.4). There was no significant difference in median OS between patients declared R/R to frontline vs salvage HMA+Ven (2.4 vs 1.8 months, hazard ratio [HR] = 0.84, 95% confidence interval [CI] 0.43-1.62). Patients who received treatment after HMA+Ven failure had longer median OS compared to patients who did not (n = 17, 4.7 vs 1.7 months, HR = 0.29, 95% CI 0.13-0.62). There was no significant difference in OS based on the sub-type of AML, ELN risk group, p53 mutation, or complex karyotype status. Conclusions: Data from our study support the clinical observation that AML patients with disease R/R to HMA+Ven, either as frontline or salvage therapy, have very poor survival outcomes. These results provide important prognostic information for clinicians and highlight the need for novel therapies for R/R AML.
Characteristic | Patient information |
---|---|
Total | 42 |
Demographics | |
Age; median (range) | 70.5 (29-88) |
Male; n (%) | 23 (54.8) |
AML characteristics; n (%) | |
de novo AML | 28 (66.7) |
Secondary AML | 8 (19.0) |
Therapy-related | 6 (14.3) |
Intermediate risk AML (ELN 2017) | 11 (26.2) |
Adverse risk AML (ELN 2017) | 31 (73.8) |
Complex karyotype | 14 (33.3) |
p53 mutant | 10 (23.8) |
Prior history of transplant | 2 (4.8) |
Treatment details | |
HMA/Ven as first line; n (%) | 23 (54.8) |
Duration on HMA/Ven prior to failure; median months (range) | 4.1 (0.4-26.3) |
Received any treatment after HMA/Ven failure; n (%) | 17 (40.5) |
AML: acute myeloid leukemia; ELN: European LeukemiaNet; HMA: Hypomethylating agent; Ven: venetoclax.
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