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Improved Responses with Azacitidine Compared to Decitabine in Patients with Acute Myeloid Leukemia in Patients ≥70 with Poor-Risk Cytogenetics
Abstracts Longer follow-up is required to determine efficacy but this approach is of particular interest for treatment of APL in medium and low income countries.
AML-219 Improved Responses with Azacitidine Compared to Decitabine in Patients with Acute Myeloid Leukemia in Patients ‡70 with Poor-Risk Cytogenetics Chetasi Talati ,1 Andrew Kuykendall,1 Najla Al-Ali,2 Rami Komrokji,2 Eric Padron,2 David Sallman,2 Alan List,2 Kendra Sweet,2 Martine Extermann,2 Jeffrey Lancet2 1
H. Lee Moffitt Cancer Center /University of South Florida, Tampa,
United States; 2H. Lee Moffitt Cancer Center, Tampa, United States
Background: Therapeutic options for patients age 70 years with acute myeloid leukemia (AML) are extremely limited and comprise mainly of clinical trials and hypomethylating agents (HMAs) including Table 1 Baseline Characteristics and Treatment Responses in the Entire Cohort Decitabine (n[89) n (%)
Azacitidine (n[163)
Male
57 (64.0%)
103 (63.2%)
Female
32 (36.0%)
60 (36.8%)
Median Age
77
76
De novo AML
39 (43.8%)
82 (50.3%)
Secondary AML
50 (56.2%)
81 (49.7%)
Gender
azacitidine (AZA) and decitabine (DEC). Thus we aim to explore clinical outcomes when treated with AZA compared to DEC. Methods: Retrospective chart review was performed to collect and analyze the clinical data for 252 patients age 70 years with diagnosis of AML treated with HMAs at Moffitt Cancer Center between 2003 and 2016. Kaplan-Meier analysis was performed to calculate overall survival (OS) with log-rank test used to calculate significance defined by p value <0.05. Results: DEC was utilized in 35.3% of the patients (n¼89) compared to AZA in 63.7% of the patients (n¼163) as a frontline treatment. Baseline characteristics are outlined in Table 1. OS of DEC cohort and AZA cohort were 11.13 vs. 15.68 months(mo) respectively (p¼0.199). Per National Comprehensive Cancer Network cytogenetics risk category of AML, patients with favorablerisk cytogenetics (FRC) were 0% vs. 1.8%, intermediate-risk cytogenetics (IRC) were 57.3% vs. 56.44%, and poor-risk cytogenetics (PRC) were 32.6% vs. 34.4% in DEC and AZA cohorts respectively. OS in IRC cohort treated with DEC was 16.5mo vs.19.3mo in AZA cohort (p¼0.432). However, the OS in PRC cohort treated with AZA was significantly greater at 10.83mo compared to 6.67mo when treated with DEC (p¼0.028). Upon further refinement of PRC cohort into harboring monosomal karyotype (MK) and non-monosomal karyotype (NMK), cohort with NMK (n¼32) had superior OS of 13.63mo compared to 8.34mo in MK cohort (n¼24) when treated with AZA (p¼0.02). Such superiority was not observed in DEC cohorts (6.43mo in MK cohort vs. 6.67mo in NMK cohort, p¼0.262). OS was higher in AZA-NMK vs. DEC-NMK cohort (13.63mo vs. 6.67mo, p¼0.01). Conclusions: Overall survival in AML patients (age 70) is not impacted by the choice of HMAs. However, we identified a subgroup of PRC cohort harboring NMK where OS was significantly greater when treated with AZA compared to DEC. Thus we recommend AZA to be considered as frontline option for elderly AML patients with PRC where benefit is derived specifically in patients harboring NMK.
Type of AML
Cytogenetic Category Favorable-Risk Cytogenetics
0 (0%)
3 (1.8%)
Intermediate-Risk Cytogenetics
51 (57.3%)
92 (56.4%)
Poor-Risk Cytogenetics
29 (32.5%)
56 (34.4%)
<10
66 (74.2%)
130 (79.8%)
>10
19 (21.3%)
24 (14.7%)
WBC
Median Platelets
54,000
73,000
Median Hemoglobin level (g/dL)
9.5
9.5
FLT3-ITD Status (Tested)
44
69
Positive
5 (11.4%)
5 (7.2%)
Negative
39 (88.6%)
64 (92.8%)
NPM1 Status (Tested)
41
71
Positive
5 (12.2%)
4 (5.6%)
Negative
36 (87.8%)
67 (94.4%)
CR+CRi
21 (23.6%)
35 (21.5%)
PR
11 (12.4%)
20 (12.3%)
SD/TF
43 (48.3%)
83 (50.9%)
Overall Responses
AML-221 Acute Leukemia Induction Related Mortality: 6-Y Experience of Saudi Tertiary Care Institute Amal Alabdulwahab , Hussein Elsayed, Mohamed Sherisher, Khaleeq Unnisa, Ahmed Zeeneldin King Abdulla Medical City-HC, Makkah, Saudi Arabia
Context: Mortality during induction therapy for acute leukemia, is a multifactorial process resulting in early treatment failure. It had shown sharp decline in the past 20 years in the Western world compared with developing countries. Objective: To determine the incidence, etiology, risk factors for mortality in acute leukemia patients who received intensive induction using conventional chemotherapy protocols. Design: A retrospective analysis of patients who were referred to KAMC-HC during the period from Mid-2011 to the first quarter of 2017 for acute leukemia treatment. Setting: The study was carried in KAMC-HC which is a relatively new tertiary care facility in the Western province of Saudi Arabia. Patients or Other Participants: 197 Patients out of 227 with acute leukemia (107 AML, 90 ALL & MPAL) who were eligible for intensive chmotherapy were included in
Clinical Lymphoma, Myeloma & Leukemia September 2017
- S295
AML-219 Improved Responses with Azacitidine Compared to Decitabine in Patients with Acute Myeloid Leukemia in Patients ‡70 with Poor-Risk Cytogenetics Chetasi Talati ,1 Andrew Kuykendall,1 Najla Al-Ali,2 Rami Komrokji,2 Eric Padron,2 David Sallman,2 Alan List,2 Kendra Sweet,2 Martine Extermann,2 Jeffrey Lancet2 1
H. Lee Moffitt Cancer Center /University of South Florida, Tampa,
United States; 2H. Lee Moffitt Cancer Center, Tampa, United States
Background: Therapeutic options for patients age 70 years with acute myeloid leukemia (AML) are extremely limited and comprise mainly of clinical trials and hypomethylating agents (HMAs) including Table 1 Baseline Characteristics and Treatment Responses in the Entire Cohort Decitabine (n[89) n (%)
Azacitidine (n[163)
Male
57 (64.0%)
103 (63.2%)
Female
32 (36.0%)
60 (36.8%)
Median Age
77
76
De novo AML
39 (43.8%)
82 (50.3%)
Secondary AML
50 (56.2%)
81 (49.7%)
Gender
azacitidine (AZA) and decitabine (DEC). Thus we aim to explore clinical outcomes when treated with AZA compared to DEC. Methods: Retrospective chart review was performed to collect and analyze the clinical data for 252 patients age 70 years with diagnosis of AML treated with HMAs at Moffitt Cancer Center between 2003 and 2016. Kaplan-Meier analysis was performed to calculate overall survival (OS) with log-rank test used to calculate significance defined by p value <0.05. Results: DEC was utilized in 35.3% of the patients (n¼89) compared to AZA in 63.7% of the patients (n¼163) as a frontline treatment. Baseline characteristics are outlined in Table 1. OS of DEC cohort and AZA cohort were 11.13 vs. 15.68 months(mo) respectively (p¼0.199). Per National Comprehensive Cancer Network cytogenetics risk category of AML, patients with favorablerisk cytogenetics (FRC) were 0% vs. 1.8%, intermediate-risk cytogenetics (IRC) were 57.3% vs. 56.44%, and poor-risk cytogenetics (PRC) were 32.6% vs. 34.4% in DEC and AZA cohorts respectively. OS in IRC cohort treated with DEC was 16.5mo vs.19.3mo in AZA cohort (p¼0.432). However, the OS in PRC cohort treated with AZA was significantly greater at 10.83mo compared to 6.67mo when treated with DEC (p¼0.028). Upon further refinement of PRC cohort into harboring monosomal karyotype (MK) and non-monosomal karyotype (NMK), cohort with NMK (n¼32) had superior OS of 13.63mo compared to 8.34mo in MK cohort (n¼24) when treated with AZA (p¼0.02). Such superiority was not observed in DEC cohorts (6.43mo in MK cohort vs. 6.67mo in NMK cohort, p¼0.262). OS was higher in AZA-NMK vs. DEC-NMK cohort (13.63mo vs. 6.67mo, p¼0.01). Conclusions: Overall survival in AML patients (age 70) is not impacted by the choice of HMAs. However, we identified a subgroup of PRC cohort harboring NMK where OS was significantly greater when treated with AZA compared to DEC. Thus we recommend AZA to be considered as frontline option for elderly AML patients with PRC where benefit is derived specifically in patients harboring NMK.
Type of AML
Cytogenetic Category Favorable-Risk Cytogenetics
0 (0%)
3 (1.8%)
Intermediate-Risk Cytogenetics
51 (57.3%)
92 (56.4%)
Poor-Risk Cytogenetics
29 (32.5%)
56 (34.4%)
<10
66 (74.2%)
130 (79.8%)
>10
19 (21.3%)
24 (14.7%)
WBC
Median Platelets
54,000
73,000
Median Hemoglobin level (g/dL)
9.5
9.5
FLT3-ITD Status (Tested)
44
69
Positive
5 (11.4%)
5 (7.2%)
Negative
39 (88.6%)
64 (92.8%)
NPM1 Status (Tested)
41
71
Positive
5 (12.2%)
4 (5.6%)
Negative
36 (87.8%)
67 (94.4%)
CR+CRi
21 (23.6%)
35 (21.5%)
PR
11 (12.4%)
20 (12.3%)
SD/TF
43 (48.3%)
83 (50.9%)
Overall Responses
AML-221 Acute Leukemia Induction Related Mortality: 6-Y Experience of Saudi Tertiary Care Institute Amal Alabdulwahab , Hussein Elsayed, Mohamed Sherisher, Khaleeq Unnisa, Ahmed Zeeneldin King Abdulla Medical City-HC, Makkah, Saudi Arabia
Context: Mortality during induction therapy for acute leukemia, is a multifactorial process resulting in early treatment failure. It had shown sharp decline in the past 20 years in the Western world compared with developing countries. Objective: To determine the incidence, etiology, risk factors for mortality in acute leukemia patients who received intensive induction using conventional chemotherapy protocols. Design: A retrospective analysis of patients who were referred to KAMC-HC during the period from Mid-2011 to the first quarter of 2017 for acute leukemia treatment. Setting: The study was carried in KAMC-HC which is a relatively new tertiary care facility in the Western province of Saudi Arabia. Patients or Other Participants: 197 Patients out of 227 with acute leukemia (107 AML, 90 ALL & MPAL) who were eligible for intensive chmotherapy were included in
Clinical Lymphoma, Myeloma & Leukemia September 2017
- S295