Intensive induction shows greater remission rates and better OS compared to nonintensive induction for patients with intermediate- or adverse-risk AML

During the 63rd American Society of Hematology (ASH) Annual Meeting and Exposition, Gail Roboz, Weill Cornell Medicine, New York, US, presented results from the study Connect® Myeloid Disease Registry (NCT01688011), investigating post remission treatment patterns and outcomes for patients with acute myeloid leukemia (AML) in a real-world cohort.¹ Remission and overall survival (OS) rates remain low in AML despite advances in treatment options.

Study design

The large, prospective, multicenter, observational cohort included patients aged ≥55 years who had been diagnosed with AML within 60 days of enrolment. Patient categories were set out according to the European LeukemiaNet (ELN) 2010 genetic prognostic factor: favorable; intermediate; adverse.

Results

Across a total of 706 patients, 313 received intensive therapy and 393 received nonintensive therapy. The median OS by age and ELN 2010 category is shown in Table 1.

Table 1. Median OS across both treatment groups*

ELN, European LeukemiaNet; NE, not evaluable; OS, overall survival. *Adapted from Roboz et al.1
Median OS, months (95% CI)	Intensive therapy (n = 313)	Nonintensive therapy (n = 393)
Whole group	22 (18–29)	11 (9–13)
By age
<60 years	38 (23–NE)	16 (9–NE)
≥60 to <70 years	24 (17–40)	13 (8–18)
≥70 years	14 (9–21)	10 (9–13)
By ELN 2010 risk
Favorable	54 (34–NE)	16 (6–NE)
Intermediate	26 (21–38)	14 (11–17)
Adverse	8 (7–11)	6 (5–8)

The most common consolidation therapy for patients in the intermediate-/adverse-risk categories was cytarabine. 42 (54.5%) patients in the intermediate-/adverse-risk categories who received consolidation underwent transplantation, compared to 8 (22.8%) patients with favorable risk. The median time from first remission to transplantation was 3.8 months for patients in the intermediate-/adverse-risk categories, compared to 9.6 months for those in the favorable risk. The number of patients who achieved remission for each treatment group is shown in Figure 1.

*Adapted from Roboz et al.¹

 Among the 261 patients achieving remission regardless of therapy, 161 had intermediate/adverse risk. Among these patients, 100 were not suitable for transplant due to age, comorbidities, and performance status. Most patients who did not undergo transplantation had some type of post remission therapy (see Table 2).

Table 2. Post remission therapy for patients who did not undergo transplantation*

*Adapted from Roboz et al.1
Post remission therapy	Patients, n (n = 100)
Consolidation—intensive chemotherapy	35
Prolonged therapy—ongoing therapy with similar agents used in low-intensity induction	27
Maintenance therapy—low-intensity agent not used during induction or consolidation	16
No post remission therapy	22

Conclusion

Treatment outcomes were consistent with expectations based on published data. Patients with ELN intermediate/adverse risk were unable to receive a transplant and, therefore, continued to have poor OS despite receiving post remission therapy.