PS1061 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)
Authors: Bernardi M.S. , Carrabba M.G. , Pavesi F. , Lorentino F. , Mastaglio S. , Messina C. , Vago L. , Gentner B. , Milani R. , Liberatore C. , Casirati G. , Sarah M. , Corti C. , Jacopo P. , Ciceri F. 
Published: June 2019

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.

Table

Summary/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.

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