Impact of Type of Induction Therapy on Outcomes in Older Adults With AML After Allogeneic Stem Cell Transplantation

Authors

Nicholas J Short
Faustine Ong
Farhad Ravandi
Graciela Nogueras-Gonzalez
Tapan M Kadia
Naval Daver
Courtney D DiNardo
Marina Konopleva
Gautam Borthakur
Betul Oran
Gheath Al-Atrash
Rohtesh Mehta
Elias J Jabbour
Musa Yilmaz
Ghayas C Issa
Abhishek Maiti
Richard E Champlin
Hagop Kantarjian
Elizabeth J Shpall
Uday Popat

Publication Date

7-25-2023

Journal

Blood Advances

Abstract

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.

Keywords

Humans, Aged, Treatment Outcome, Induction Chemotherapy, Retrospective Studies, Transplantation, Homologous, Leukemia, Myeloid, Acute, Recurrence, Hematopoietic Stem Cell Transplantation

Comments

Supplementary Materials

PMID: 37104058