Intermediate-dose cytarabine after CPX‑351 induction for secondary AML

A retrospective, multicenter Italian study evaluated the feasibility and efficacy of intermediate-dose cytarabine (IDAC) consolidation after achieving composite complete response (CRc) with ≥1 induction cycle of CPX‑351, a liposomal formulation of cytarabine and daunorubicin, in patients with secondary acute myeloid leukemia (s‑AML; N = 47). Results were published in Annals of Hematology by Perrone et al.

Key data: At a median follow-up of 14.8 months, median overall survival (OS) was 21 months (95% confidence interval [CI], 11.5–30.4), with 85% and 48.4% of patients alive at 12 and 24 months, respectively. The median event-free survival (EFS) was 14.9 months (95% CI, 11.7–28.2 months). Multivariate analysis identified adverse-risk disease per the European LeukemiaNet (ELN) 2017 classification (hazard ratio [HR], 4.32; 95% CI, 1.05–17.71; p = 0.042) and measurable residual disease (MRD) positivity prior to IDAC treatment (HR, 2.97; 95% CI, 1.18–7.49; p = 0.021) as independent negative predictors of OS. Adverse events (AEs) of any grade occurred in 57% of patients; most cases were infections, and no toxic deaths were reported.

Key learning: These Italian real-world data show IDAC may be a feasible consolidation strategy with a manageable safety profile following CPX‑351 induction in patients with s‑AML, while adverse-risk disease and pre‑IDAC MRD positivity were negative prognostic factors. Findings warrant further prospective investigation of IDAC consolidation in this population.