TY - JOUR
T1 - Impact of type of induction therapy on outcomes in older adults with AML after allogeneic stem cell transplantation
AU - Short, Nicholas J
AU - Ong, Faustine
AU - Ravandi-Kashani, Farhad
AU - Nogueras Gonzalez, Graciela
AU - Kadia, Tapan Mahendra
AU - Daver, Naval
AU - DiNardo, Courtney D.
AU - Konopleva, Marina
AU - Borthakur, Gautam
AU - Oran, Betul
AU - Al-Atrash, Gheath
AU - Mehta, Rohtesh S
AU - Jabbour, Elias Joseph
AU - Yilmaz, Musa
AU - Issa, Ghayas C
AU - Maiti, Abhishek
AU - Champlin, Richard E
AU - Kantarjian, Hagop M
AU - Shpall, Elizabeth
AU - Popat, Uday R
N1 - Funding Information:
This research was funded in part by the National Institutes of Health/National Cancer Institute Cancer Center (support grant P30) (CA016672).
Funding Information:
Conflict-of-interest disclosure: F.R., C.D.D., and M.K. received honoraria and research funding from AbbVie. G.B. received honoraria from AbbVie. U.P. received research funding from AbbVie. The remaining authors declare no competing financial interests.
Publisher Copyright:
© 2023 by The American Society of Hematology.
PY - 2023/7/25
Y1 - 2023/7/25
N2 - Although venetoclax-based lower-intensity regimens have greatly improved outcomes for older adults with acute myeloid leukemia (AML) who are unfit for intensive chemotherapy, the optimal induction for older patients with newly diagnosed AML who are suitable candidates for hematopoietic stem cell transplant (HSCT) is controversial. We retrospectively analyzed the post HSCT outcomes of 127 patients ≥60 years of age who received induction therapy at our institution with intensive chemotherapy (IC; n = 44), lower-intensity therapy (LIT) without venetoclax (n = 29), or LIT with venetoclax (n = 54) and who underwent allogeneic HSCT in the first remission. The 2-year relapse-free survival (RFS) was 60% with LIT with venetoclax vs 54% with IC, and 41% with LIT without venetoclax; the 2-year overall survival (OS) was 72% LIT with venetoclax vs 58% with IC, and 41% with LIT without venetoclax. The benefit of LIT with venetoclax induction was greatest in patients with adverse-risk AML (2-year OS: 74%, 46%, and 29%, respectively). Induction with LIT, with or without venetoclax, was associated with the lowest rate of nonrelapse mortality (NRM) (2-year NRM: 17% vs 27% with IC; P = .04). Using multivariate analysis, the type of induction therapy did not significantly affect any of the post HSCT outcomes evaluated; hematopoietic cell transplantation-specific comorbidity index was the only factor that independently predicted RFS and OS. LIT plus venetoclax followed by HSCT is a feasible treatment strategy in older, fit, HSCT-eligible patients with newly diagnosed AML and may be particularly beneficial for those with adverse-risk disease.
AB - Although venetoclax-based lower-intensity regimens have greatly improved outcomes for older adults with acute myeloid leukemia (AML) who are unfit for intensive chemotherapy, the optimal induction for older patients with newly diagnosed AML who are suitable candidates for hematopoietic stem cell transplant (HSCT) is controversial. We retrospectively analyzed the post HSCT outcomes of 127 patients ≥60 years of age who received induction therapy at our institution with intensive chemotherapy (IC; n = 44), lower-intensity therapy (LIT) without venetoclax (n = 29), or LIT with venetoclax (n = 54) and who underwent allogeneic HSCT in the first remission. The 2-year relapse-free survival (RFS) was 60% with LIT with venetoclax vs 54% with IC, and 41% with LIT without venetoclax; the 2-year overall survival (OS) was 72% LIT with venetoclax vs 58% with IC, and 41% with LIT without venetoclax. The benefit of LIT with venetoclax induction was greatest in patients with adverse-risk AML (2-year OS: 74%, 46%, and 29%, respectively). Induction with LIT, with or without venetoclax, was associated with the lowest rate of nonrelapse mortality (NRM) (2-year NRM: 17% vs 27% with IC; P = .04). Using multivariate analysis, the type of induction therapy did not significantly affect any of the post HSCT outcomes evaluated; hematopoietic cell transplantation-specific comorbidity index was the only factor that independently predicted RFS and OS. LIT plus venetoclax followed by HSCT is a feasible treatment strategy in older, fit, HSCT-eligible patients with newly diagnosed AML and may be particularly beneficial for those with adverse-risk disease.
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U2 - 10.1182/BLOODADVANCES.2022009632
DO - 10.1182/BLOODADVANCES.2022009632
M3 - Article
C2 - 37104058
AN - SCOPUS:85170576087
SN - 2473-9529
VL - 7
SP - 3573
EP - 3581
JO - Blood Advances
JF - Blood Advances
IS - 14
ER -