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Searching for Optimal Front-Line Approach to Treated Secondary AML

By: Lauren Harrison, MS
Posted: Monday, March 28, 2022

Outcomes for patients with treated secondary acute myeloid leukemia (AML) or AML that arose from a previously treated antecedent hematologic disorder may be improved with the combined use of a hypomethylating agent, a venetoclax-based regimen, and hematopoietic stem cell transplantation. Nicholas J. Short, MD, of The University of Texas MD Anderson Cancer Center, Houston, and colleagues published these findings in the Journal of Hematology & Oncology.

This study retrospectively analyzed 562 patients who developed AML from a preceding myelodysplastic syndrome or chronic myeloid leukemia and received hypomethylating-based therapy for their preceding hematologic disorder. Patients were assigned to three groups according to the therapy they had received for AML: intensive chemotherapy (271 patients), low-intensity therapy without venetoclax (237 patients), and a hypomethylating agent plus venetoclax (54 patients). Mutation profiling was conducted on bone marrow specimens from patient samples as well.

For the entire study cohort, the complete remission rate was 16%, and 26% of patients achieved complete remission or complete remission with incomplete hematologic recovery. The median duration of response was 7.7 months, and the median overall survival was 4.8 months. Among the patients receiving a hypomethylating agent plus venetoclax, the median overall survival was 5.8 months. In the intensive chemotherapy group, overall survival was 4.5 months, whereas it was 4.8 months with low-intensity therapy without venetoclax.

As for a subgroup of patients with adverse-risk AML karyotypes, all three treatment regimens yielded poor outcomes (3.3 months for hypomethylating agents plus venetoclax, 4.6 months for intensive chemotherapy, and 4.0 months for low-intensity chemotherapy). In patients with nonadverse-risk karyotypes, the overall survival was superior among those receiving hypomethylating agents and venetoclax (13.7 months) compared with intensive (5.0 months) and low-intensity (6.3 months) chemotherapy. In addition, those who received hematopoietic stem cell transplantation had a 3-year overall survival rate of 33%, compared with 8% for those who did not undergo transplantation.

Disclosure: The study authors reported no conflicts of interest.


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