ELDERLY PATIENTS WITH DE NOVO OR SECONDARY AML HAVE COMPARABLE OUTCOMES AFTER INTENSIVE TREATMENTS INCLUDING HIGH DOSE (HD) CYTARABINE AND AUTOLOGOUS (AUTO) OR ALLOGENEIC (ALLO) TRANSPLANTATION (SCT)
Author(s): ,
Massimo stefano Bernardi
Affiliations:
Haematology,IRCCS SAN RAFFAELE SCIENTIFIC INSTITUTE,Milano,Italy
,
Matteo Giovanni Carrabba
Affiliations:
Haematology,IRCCS SAN RAFFAELE SCIENTIFIC INSTITUTE,Milano,Italy
,
Francesca Pavesi
Affiliations:
Haematology,IRCCS SAN RAFFAELE SCIENTIFIC INSTITUTE,Milano,Italy
,
Francesca Lorentino
Affiliations:
Haematology,IRCCS SAN RAFFAELE SCIENTIFIC INSTITUTE,Milano,Italy
,
Sara Mastaglio
Affiliations:
Haematology,IRCCS SAN RAFFAELE SCIENTIFIC INSTITUTE,Milano,Italy
,
Carlo Messina
Affiliations:
Haematology,IRCCS SAN RAFFAELE SCIENTIFIC INSTITUTE,Milano,Italy
,
Luca Vago
Affiliations:
Haematology,IRCCS SAN RAFFAELE SCIENTIFIC INSTITUTE,Milano,Italy
,
Bernhard Gentner
Affiliations:
Haematology,IRCCS SAN RAFFAELE SCIENTIFIC INSTITUTE,Milano,Italy
,
Raffaella Milani
Affiliations:
Flow-cytometry and cell manipulation lab,IRCCS SAN RAFFAELE SCIENTIFIC INSTITUTE,Milano,Italy
,
Carmine Liberatore
Affiliations:
Haematology,IRCCS SAN RAFFAELE SCIENTIFIC INSTITUTE,Milano,Italy
,
Gabriele Casirati
Affiliations:
Haematology,IRCCS SAN RAFFAELE SCIENTIFIC INSTITUTE,Milano,Italy
,
Marktel Sarah
Affiliations:
Haematology,IRCCS SAN RAFFAELE SCIENTIFIC INSTITUTE,Milano,Italy
,
Consuelo Corti
Affiliations:
Haematology,IRCCS SAN RAFFAELE SCIENTIFIC INSTITUTE,Milano,Italy
,
Peccatori Jacopo
Affiliations:
Haematology,IRCCS SAN RAFFAELE SCIENTIFIC INSTITUTE,Milano,Italy
Fabio Ciceri
Affiliations:
Haematology,IRCCS SAN RAFFAELE SCIENTIFIC INSTITUTE,Milano,Italy
EHA Library. Bernardi M. Jun 15, 2019; 266678; PS1061
Dr. Massimo Bernardi
Dr. Massimo Bernardi
Contributions
Abstract

Abstract: PS1061

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background

secondary acute myeloid leukemia (s-AML) represent a high-risk AML subset with poor outcome, worse than denovo AML. Of note, most patients (pts) are older than 60 years and have comorbidities, frequently tailoring under-powered treatment. At our center, we offer intensive treatments to selected elderly AML pts, according to patient’s fitness and AML prognostic risk factors. Here we present data of our denovo and secondary AML pts treated during the last 18 yrs.

Aims
to compare outcomes of denovo AML and sAML pts, older than 60, after intensive treatments at our center

Methods
retrospective analysis of data from 123 pts with untreated AML, 66 sAML and 57 denovo AML, diagnosed between 10/2001-1/2019, median age 68 y (61-78) in both groups. Criteria for pts selection to receive intensive treatments: PS (ECOG) ≤ 2, renal and hepatic parameters < 2 times normal values, no active infections and cardiac ejection fraction > 50%. Categorical data were compared by the Fisher's exact test, overall survival (OS) and disease free survival (DFS) were analysed and compared by the Kaplan-Meier method and Log-Rank Test, relapse incidence by the Gray Test.

Results
distribution of pts in the genetic risk groups (ELN2017, 70 pts evaluable) significantly differed only for pts in the favourable one: 1 sAML patient, 13 denovo AML pts, p=0.0003. Induction and post remission standard (CHT) and high dose (HDARAC) cycles of chemotherapy are reported in tab1. sAML pts received more HDARAC cycles than denovo AML pts. CR rate: sAML 70% (46 pts), denovo AML 72% (41 pts), p=ns. CR after first induction (C1): sAML 53% (35 pts), denovo AML 54% (31 pts), p=ns. In sAML pts only, CR rate after C1 with HDARAC was significantly higher than with CHT: 64% (30 pts) and 26% (5 pts), respectively, p=0.0072. Second induction was HDARAC for most pts not in CR after C1. TRM of the induction phase: sAML 3% (2 pts) and denovo AML 10.5% (6 pts), p=ns. Further 6 pts obtained the CR after alloSCT, 5 sAML and 1 denovo AML. Relapse incidence (RI): @3y sAML 38±12% and denovo AML 48±14%. Overall survival (OS): median, sAML 515 days and denovo AML 389 days, @3y sAML 37% and denovo AML 31%, p=ns. Disease free survival (DFS): median, sAML 470 days and denovo AML 313 days, @3y sAML 30% and denovo AML 22%, p=ns.

Tab1

 

sAML

denovo AML

p

Induction C1/C2, pts n°

66/15

57/14

 

CHT (3+7 or 5+2 or ICE)

19 (29%)/1

50 (88%)/2

0.0001/ns

HDARAC (8-24 gr/sqm of cytarabine in 4-6 days)

47 (71%)/14

7 (12%)/12

Post remission treatments, pts n°

46

41

 

None/CHT

0/2

1/2

ns

HDARAC/ Auto SCT/ Allo SCT

15/10/19

17/13/8

Conclusion
CR rate and long term survival were encouraging and comparable in the two studied groups of pts. More intensive induction with HDARAC in sAML than denovo AML pts was the only significantly different variable in the two groups. HDARAC probably induced a more profound remission in our pts overcoming the unfavourable biologic characteristics of sAML. Of note, intensive post-remission treatments, including auto and allo SCT, proved feasible either after CHT either after HDARAC induction in our elderly pts. In conclusion, we suggest to consider initial treatment with HDARAC for sAML pts, fit for intensive treatments.

Session topic: 4. Acute myeloid leukemia - Clinical

Keyword(s): Acute myeloid leukemia, Elderly, Treatment

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