Contributions
Abstract: PB1403
Type: Publication Only
Session title: Acute myeloid leukemia - Clinical
Background
Hypomethylating agents (HMAs), azacitidine and decitabine, are a standard of care in high risk myelodysplastic syndromes (MDS) and in acute myeloid leukemia (AML) patients ineligible for intensive therapy. The clinical activity of HMAs in myeloid neoplasms has been firmly established now, but still remains limited in the real world especially in terms of using after failure of the first HMA.
Aims
In this study, it was aimed to evaluate the clinical and laboratory characteristics of patients with MDS and AML who were treated with HMAs, as well as their treatment responses and factors affecting prognosis.
Methods
A hundred and twenty patients, over the age of 18 who were diagnosed AML or MDS according to WHO 2008 diagnostic criteria between August 2010 and February 2020 and received at least 4 cycles of HMA were included in the study. The data was collected retrospectively.
Results
Seventy four (61.7%) of patients were male and 46 (38.3%) were female. The diagnosis was MDS in 63 (52.5%) and AML in 57 (47.5%) of patients. The mean age at the time of diagnosis was 69.9 ± 12 years. Sixty four (53.3%) of the patients received only azacitidine, 8 (6.7%) only decitabine, and 48 (40%) azacitidine and decitabine consecutively. When we compared the laboratory findings before and after HMA treatment, there was an improvement in hemoglobin level, white blood cell, neutrophil, platelet and blast counts (p<0.05). The need for red blood cell and platelet suspensions during HMA treatment was significantly higher than the pre-treatment period (p <0.001). While febrile neutropenia (FN) developed in 96 (80%) of the patients totally, FN developed in 75 (66.9%) of 112 patients who received azacitidine and in 49 (87.5%) of 56 patients who received decitabine. Complete response, partial response or hematological recovery was detected in 63 (52.5%) of the patients. Relapse or progression developed in 81 (67.5%) patients. Response rates were similar in patients with AML and MDS (p=0.48). FN and relapse or progression were significantly higher in AML patients (p = 0.007 and p = 0.03). Survival in MDS was longer than AML patients (17.2±9 vs 12±6.7 months, p = 0.003).
Single cox-regression analysis revealed that mortality risk was 2.2 times higher in AML patients compared to MDS (HR=0.45, p=0.01, 95% CI 0.28–0.73). High blast ratio in flow cytometry before treatment, presence of poor risk cytogenetic before treatment, high blast ratio in flow cytometry after treatment, high blast ratio in post-treatment bone marrow biopsy, poor risk cytogenetic after treatment, increased number of platelet suspensions before treatment, presence of FN, length of hospitalization, no response to treatment and presence of relapse / progression were poor prognostic in terms of survival.
Multiple cox-regression analysis revealed that the mortality risk in AML patients was 2.39 times higher than MDS patients (p = 0.03, 95% CI 1.04--5.5). Those with a higher pre-treatment platelet suspension replacement and those who had FN had a higher risk. The mortality decreased as the number of azacitidine cycles increased (HR = 0.9, p = 0.002 (95% CR 0.84-0.96).
Conclusion
In conclusion, response rates are similar in AML and MDS treated with HMAs. Although FN and relapse/progression are higher, and survival is shorter in AML, HMAs are effective in MDS and AML patients witha response rate of 52.5%.
Keyword(s): Acute myeloid leukemia, Azacitidine, Decitabine, Myelodysplasia
Abstract: PB1403
Type: Publication Only
Session title: Acute myeloid leukemia - Clinical
Background
Hypomethylating agents (HMAs), azacitidine and decitabine, are a standard of care in high risk myelodysplastic syndromes (MDS) and in acute myeloid leukemia (AML) patients ineligible for intensive therapy. The clinical activity of HMAs in myeloid neoplasms has been firmly established now, but still remains limited in the real world especially in terms of using after failure of the first HMA.
Aims
In this study, it was aimed to evaluate the clinical and laboratory characteristics of patients with MDS and AML who were treated with HMAs, as well as their treatment responses and factors affecting prognosis.
Methods
A hundred and twenty patients, over the age of 18 who were diagnosed AML or MDS according to WHO 2008 diagnostic criteria between August 2010 and February 2020 and received at least 4 cycles of HMA were included in the study. The data was collected retrospectively.
Results
Seventy four (61.7%) of patients were male and 46 (38.3%) were female. The diagnosis was MDS in 63 (52.5%) and AML in 57 (47.5%) of patients. The mean age at the time of diagnosis was 69.9 ± 12 years. Sixty four (53.3%) of the patients received only azacitidine, 8 (6.7%) only decitabine, and 48 (40%) azacitidine and decitabine consecutively. When we compared the laboratory findings before and after HMA treatment, there was an improvement in hemoglobin level, white blood cell, neutrophil, platelet and blast counts (p<0.05). The need for red blood cell and platelet suspensions during HMA treatment was significantly higher than the pre-treatment period (p <0.001). While febrile neutropenia (FN) developed in 96 (80%) of the patients totally, FN developed in 75 (66.9%) of 112 patients who received azacitidine and in 49 (87.5%) of 56 patients who received decitabine. Complete response, partial response or hematological recovery was detected in 63 (52.5%) of the patients. Relapse or progression developed in 81 (67.5%) patients. Response rates were similar in patients with AML and MDS (p=0.48). FN and relapse or progression were significantly higher in AML patients (p = 0.007 and p = 0.03). Survival in MDS was longer than AML patients (17.2±9 vs 12±6.7 months, p = 0.003).
Single cox-regression analysis revealed that mortality risk was 2.2 times higher in AML patients compared to MDS (HR=0.45, p=0.01, 95% CI 0.28–0.73). High blast ratio in flow cytometry before treatment, presence of poor risk cytogenetic before treatment, high blast ratio in flow cytometry after treatment, high blast ratio in post-treatment bone marrow biopsy, poor risk cytogenetic after treatment, increased number of platelet suspensions before treatment, presence of FN, length of hospitalization, no response to treatment and presence of relapse / progression were poor prognostic in terms of survival.
Multiple cox-regression analysis revealed that the mortality risk in AML patients was 2.39 times higher than MDS patients (p = 0.03, 95% CI 1.04--5.5). Those with a higher pre-treatment platelet suspension replacement and those who had FN had a higher risk. The mortality decreased as the number of azacitidine cycles increased (HR = 0.9, p = 0.002 (95% CR 0.84-0.96).
Conclusion
In conclusion, response rates are similar in AML and MDS treated with HMAs. Although FN and relapse/progression are higher, and survival is shorter in AML, HMAs are effective in MDS and AML patients witha response rate of 52.5%.
Keyword(s): Acute myeloid leukemia, Azacitidine, Decitabine, Myelodysplasia