Title: AML-095 Findings From an Analysis of Patients With Monocytic and Monocytic-Like Acute Myeloid Leukemia (AML), Including AML-M4 and AML-M5, Treated With Venetoclax (Ven) Plus Azacitidine (Aza)
Abstract: Background: Secondary acute myeloid leukemia (sAML) is associated with shorter survival compared with de novo AML and remains a challenge in hematologic oncology.Among sAML, therapy-related AML (tAML) arises from prior cytotoxic, radiation, or immunosuppressive therapy, while myelodysplastic/ myeloproliferative neoplasm-AML (MDS/MPN-AML) develops from the previous clonal disorder of hematopoiesis.Aims: To characterize MDS/MPN-AML and tAML patients, evaluate relevant prognostic factors for survival, and assess treatment outcomes.Methods: We conducted a single-center retrospective analysis of MDS/MPN-AML and tAML patients diagnosed between 2013-2018 in our hematology department in Lodz, Poland.Results: The study included 110 patients with MDS/MPN-AML (78) and tAML (32), median age, 66.The median follow-up was 3.2 months (95% CI:2.5-5.3).The most common hematological disorder preceding sAML was MDS (48), while the most frequent neoplasm previous to tAML was breast cancer (9).In multivariate Cox regression, age at diagnosis (95% CI:1.00-1.06),higher ECOG Performance Status score (2-4 vs 0-1) (95% CI:1.08-3.15),hypoalbuminemia (95% CI:1.95-5.24),and bone marrow blasts percentage (95% CI:1.00-1.03)were independent predictors of poor survival.The intensive treatment was related to longer survival (95% CI:0.21-0.82).The median overall survival (OS) for MDS/MPN-AML patients was 4.1 months (95% CI:2.5-7.0) and for tAML, 2.8 months (95% CI:1.6-5.6).There were no differences in OS between MDS/MPN-AML and tAML (log-rank test: P=0.86) or within particular groups: MDS-AML vs MPN-AML (P=0.21) and comparing each tAML subgroup separately (P=0.19).In patients treated intensively, the median OS was 13.9 months (95%CI:7.9-24.5),and in patients treated nonintensively, 2.5 months (95% CI:1.6-3.0)(3.3, 2.9, 1.0 months for LD-AraC, azacitidine, and best supportive care/ hydroxyurea, respectively) (P<0.0001).The allo-HSCT importance in improving survival is emphasized, although few patients (8) were eligible for the procedure and no effect was shown on significantly prolonging OS, considering the intensively treated (P=0.14). Conclusions:The prognosis for sAML is poor.Both the MDS/ MPN-AML and tAML patients showed similar characteristics and no significant differences in OS.Variables like age, ECOG score, blasts level infiltration, and albumins are independent predictors for OS.The positive influence of intensive treatment can be highlighted.