Treatment patterns and outcomes in secondary acute myeloid leukemia arising after hypomethylating agents: PETHEMA registry study.
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Lloret-Madrid Pilar, Boluda Blanca, Martínez-López Joaquín, Bergua Juan, Rodriguez Arboli Eduardo, Labrador Jorge, Sossa Claudia, Gil Cristina, Algarra Lorenzo, Lavilla-Rubira Esperanza, Serrano Josefina, de Rueda Beatriz, Ibañez Francisco, González González Bernardo J, Amigo María Luz, García Belmonte Daniel, Rodríguez-Medina Carlos, Gómez-Roncero María I, Colorado Mercedes, López Lorenzo José L, Tormo Mar, Arce Fernández Olga, Cano-Ferri Isabel, Solana-Altabella Antonio, Foncillas Maria-Angeles, Alfonso Pierola Ana, Vives Susana, Núñez Marta Valero, López-Vidal Hernán, Pérez-Santaolalla Esther, Hermosín Ramos Lourdes, García Boyero Raimundo, Llorente González Laura, Roldán Alicia, Calderón Soledad Casado, Infante Joana Brioso, Olave Teresa, García-Suárez Julio, de Laiglesia Almudena, Rodríguez-Veiga Rebeca, Trigo Fernanda, Martínez-Cuadrón David, Montesinos Pau
Аннотация
METHODS: The authors analyze the characteristics, therapeutic approaches, and outcomes of patients with HMA-sAML from the Programa Español para el Tratamiento de Hemopatías Malignas (PETHEMA) registry.
RESULTS: A total of 479 patients were included, mostly from prior myelodysplastic syndrome (84%). Frontline therapy consisted of intensive chemotherapy (IC) in 31%, low-dose cytarabine-based in 19%, supportive care and clinical trial 17% each, and HMA-based therapy in 12% and 4% in venetoclax-based regimen. Complete remission was achieved in 95 patients (27%), with higher rate among IC and venetoclax-based groups (44% and 41%, respectively). The median overall survival (OS) was 4.93 months, with 7.68 months for IC patients, 7.82 months after HMA monotherapy, and 4.66 months after venetoclax-based regimens. Patients who underwent allogeneic hematopoietic stem cell transplantation in first remission (n = 33, 9%) had a better survival outcome (median OS not reached). Multivariate analyses identified age (≥65 years), Eastern Cooperative Oncology Group >2, higher white blood cell count, and adverse risk cytogenetic as adverse prognostic factors, whereas NPM1 mutation was a favorable factor.
CONCLUSIONS: Patients with HMA-sAML have a poor prognosis and suboptimal outcomes with conventional treatments, including BCL2 inhibitors, highlighting the need for clinical trials targeting this population.