HMA + Ven vs IC in ND AML with chromosome 5 and/or 7 abnormalities

Results from a multicenter retrospective study, comparing hypomethylating agent (HMA) + venetoclax (Ven) vs intensive chemotherapy (IC) in 246 patients with newly diagnosed acute myeloid leukemia (AML) who had chromosome 5 and/or 7 abnormalities (deletion 5 or 5q [−5/del5q] and/or deletion 7 [−7]), were published in Haematologica by Boussi et al. The primary endpoints were measurable residual disease (MRD) negativity rates and overall survival (OS). 

Key data: A total of 85 patients received IC and 161 patients received HMA + Ven. The complete remission (CR)/CR with incomplete hematologic recovery (CRi) rate among patients receiving IC was 43% vs 52% in patients receiving HMA + Ven (p = 0.20). Among patients with MRD flow cytometry data, MRD-negativity rates were 50% vs 43% in patients treated with IC (n = 18) vs HMA + Ven (n = 37), respectively (p = 0.77). Patients who received IC had a median OS of 11 months (95% confidence interval [CI], 8.1–16) compared with 6.3 months (95% CI, 5.7–7.8) in patients who received HMA + Ven (p = 0.0013). In a multivariate analysis, age at diagnosis (p = 0.0324), prior myeloid disease (p = 0.0266), monosomal karyotype (p = 0.029), and KRAS mutation (p = 0.0063) were associated with poorer OS, while allogeneic hematopoietic stem cell transplantation (allo-HSCT) was associated with improved OS (p < 0.0001). There was no difference in OS between patients receiving HMA + Ven vs IC in the multivariate analysis (p = 0.9202).

Key learning: IC and HMA + Ven demonstrated comparable CR and MRD-negativity rates in patients with AML who had chromosome 5 and/or 7 abnormalities, while OS was significantly longer in patients who received IC vs HMA + Ven. Factors including age at diagnosis, prior myeloid disease, monosomal karyotype, KRAS mutation, and allo-HSCT may be useful predictive markers for outcomes with IC and HMA + Ven.