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Approximately 30% of patients with acute myeloid leukemia (AML) have nucleophosmin-1 mutations (NPM1+), which are associated with a favorable prognosis.1 However, the beneficial impact of this mutation decreases with increasing age in patients treated with standard intensive chemotherapy (IC) or hypomethylating agents (HMAs).2 Newer studies have also shown venetoclax (VEN)-based treatment regimens to be efficacious in the treatment of NPM1+ AML.3,4
Curtis A. Lachowiez and colleagues have recently published the results of a retrospective study in the journal Blood Advances, which compares HMA plus VEN, HMA monotherapy, or IC treatment regimens for older patients (> 65 years) with NPM1+ AML.5
Figure 1. Percentage of patients included in each cohort
HMA, hypomethylating agents; IC, intensive chemotherapy; VEN, venetoclax
Table 1. Baseline patient demographics
AML, acute myeloid leukemia; HMA, hypomethylating agents; IC, intensive chemotherapy; VEN, venetoclax *HMA plus VEN vs IC Data are n |
||||
|
HMA plus VEN (n = 28) |
HMA (n = 47) |
IC (n = 228) |
p |
---|---|---|---|---|
Median age, years |
71 |
72 |
55 |
0.0001 |
< 55 |
- |
- |
114 |
|
55–65 |
2 |
8 |
89 |
|
> 65 |
26 (median, 72) |
39 (median, 75) |
25 (median, 68) |
0.0040* |
Performance status |
|
|
|
|
0–1 |
15 |
23 |
180 |
0.0002 |
2–3 |
9 |
13 |
27 |
|
AML subtype |
|
|
|
|
De novo |
25 |
35 |
213 |
0.0010 |
Secondary |
1 |
6 |
4 |
- |
Treated secondary |
2 |
6 |
11 |
- |
Table 2. Treatment outcomes
CR, complete response; HMA, hypomethylating agents; IC, intensive chemotherapy; MRD, measurable residual disease; VEN, venetoclax *HMA plus VEN vs HMA †HMA plus VEN vs IC |
||||
|
HMA plus VEN (n = 28) |
HMA (n = 47) |
IC (n = 228) |
p |
---|---|---|---|---|
% CR by age, y |
|
|
|
|
< 55 |
— |
— |
89 |
— |
55–65 |
100 |
13 |
88 |
0.067* 1.000† |
> 65 |
88 |
28 |
56 |
<0.001* 0.013† |
Total |
89 |
26 |
85 |
<0.001* 0.778† |
MRD negativity |
75 |
27 |
79 |
0.011* 0.593† |
These results provide further evidence of the improved outcomes of using HMA combinations over HMA monotherapy as a treatment for older patients with NPM1+ AML. However, the authors acknowledge that limitations of this study include its retrospective nature, as well as small sample sizes for the HMA plus VEN, and HMA cohorts.
References
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