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In newly diagnosed acute myeloid leukemia (AML), risk stratification relies mostly on cytogenetics, genetics, age, fitness, and other causal factors. Based on its clinical evolution, AML can be classified into three categories: secondary AML (s-AML), arising after an antecedent myelodysplastic syndrome (MDS); therapy-related AML (t-AML) developing after chemotherapy; or de novo AML arising without an identifiable cause. s-AML and t-AML are associated with inferior prognosis compared with de novo AML, and are clinically and genetically heterogeneous, with gene mutations in s-AML closely associated with MDS.1
CPX-351, a novel dual-drug liposomal encapsulation of cytarabine and daunorubicin, is approved by the U.S. Food & Drug Administration and EMA for the treatment of adults with newly diagnosed t-AML, and AML with myelodysplasia-related changes, based on the results of a randomized phase III trial (NCT01696084). Association of cytogenetic factors with outcome after CPX-351 use has so far not been studied.
At the 61st American Society of Hematology Annual Meeting & Exposition, Coleman Lindsley, Dana-Farber/Harvard Cancer Center, Boston, US, presented the results of a study evaluating the genetic characteristics of patients enrolled in the phase III trial and the impact of gene mutations on outcomes.2
CI, confidence interval; NR, not reached |
||||
Gene |
CPX-351 |
7+3 |
||
Mutated |
Unmutated |
Mutated |
Unmutated |
|
TP53 (95% CI) |
5.7 (3─7.6) |
10.9 (7─26.3) |
5.1 (2.6─7.4) |
9.4 (4.6─12.2) |
SRSF2, U2AF1, SF3B1, ZRSR2, ASXL1, BCOR, EZH2, STAG2 (secondary-type mutations) (95% CI) |
10.1 (6.4─18.5) |
6 (4.3─12) |
6.6 (3.6─9.5) |
7.3 (4.3─9.8) |
FLT3, NRAS, KRAS, PTPN11, NF1, CBL, RIT1 (activated signaling mutations) (95% CI) |
7 (3.8─9.3) |
11.3 (5.6─NR) |
5.7 (3.2─8.6) |
7.6 (4.3─10.9) |
ASXL1 (95% CI) |
8.9 (5.4─18.7) |
7.6 (5.6─12) |
6.6 (3.3─11.7) |
7.3 (4─9.2) |
TET2 (95% CI) |
9.3 (5.3─18.7) |
7.5 (5.5─12) |
4.1 (1.9─5.9) |
7.8 (4.9─10.9) |
RUNX1 (95% CI) |
8.9 (3.5─11.9) |
7.7 (5.7─13) |
4.7 (1.5─6.6) |
8.2 (4.6─10.9) |
DNMT3A (95% CI) |
26.3 (7─NR) |
7.4 (5.3─10.1) |
6.4 (2.3─10.9) |
7.4 (4─9.6) |
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