Retrospective Analysis of Chemotherapy Intensity and Allogeneic Stem Cell Transplant on Patients with Myelodysplastic Syndrome Associated Acute Myeloid Leukemia - a Single Institution Experience
Authors: Batayneh Osama , Hernandez Carina , Afridi Safa , Vazquez Almonte Margarita , Passafiume Daniella , Parekh Deevyashali , Sandhu Michael , Goodman Alexandra , Gupta Angela , Rao Gergal Gopalakrishna Rao Sanjay , Wallace Josh , Gentile Teresa 
Published: December 2024

Introduction
Acute myeloid leukemia secondary to antecedent myelodysplastic syndrome (AML/MDS) is often associated with worse overall outcomes. Despite the advances in novel therapies, such as liposomal cytarabine/daunorubicin and molecular targeted therapies, patients without allogeneic stem cell transplantation (allo SCT) generally have inferior outcomes. This leaves patients with AML/MDS with unmet clinical needs. Many times, these patients are treated with less intensive chemotherapy with a goal of palliation. We performed this retrospective analysis to assess the effect of chemotherapy intensity and subsequent allo SCT on complete remission (CR) overall survival (OS).
Methods
A retrospective analysis was conducted on a patient cohort at SUNY Upstate Medical University Hospital. The records were reviewed in EPIC electronic medical records from January 2010 to June 2024 using slicer dicer search tool. The subjects were at least 18 years of age or older and had a confirmed diagnosis of secondary AML with MDS. Patients who did not receive any treatment or were diagnosed with other secondary subtypes of AML, such as therapy-related AML or AML/MPN, were not included in the study. We examined the effects of chemotherapy intensity and allo SCT and its impact on CR and OS. Statistical analysis system (SAS) software, version 9.4 was used for data analysis. Survival analysis included Kaplan Meier curves with a chi-square for statistical significance.
Results
Fifty patients were identified. Most patients were above the age of 60 (n=39). 24 patients received intensive chemotherapy while 26 patients received non-intensive chemotherapy. TP53 mutations were present in 14 out of the 50 patients (28%). The mean time to induction chemotherapy from diagnosis was 6.4 days. 9 (18%) patients underwent allo SCT, 2 out of 9 without achieving CR1 prior to transplant. Patients who received intensive chemotherapy trended toward a higher CR which was not statistically significant (P=0.26). In comparison to non-intensive chemotherapy, intensive chemotherapy was associated with improved OS (HR=0.507, 95% CI 0.266 - 0.966). Our model showed that patients who proceeded to allo SCT had a decreased risk of death compared to patients who did not have a transplant (HR= 0.311, 95% CI 0.128 - 0.756).
Conclusion
Patients with AML/MDS who received intensive chemotherapy in our institution had a decreased risk of death compared to those receiving non-intensive chemotherapy. Patients who proceeded with subsequent allo SCT also had improved survival. Given that the majority of these patients were above the age of 60, these findings support a careful and thorough assessment for both chemotherapy intensity and transplant candidacy before initiating induction chemotherapy in order to improve survival.