Abstracts Clinical Lymphoma, Myeloma & Leukemia September 2023 S266 AML-086 Assessment of Prognostic Factors for Survival and Treatment Outcomes of Patients With Secondary Acute Myeloid Leukemia Piotr Strzałka MD1, Kinga Krawiec MD1, Sylwia Szydłowska MD2, Damian Mikulski MD1, Magdalena Czemerska MD, PhD1, Agnieszka Pluta MD, PhD1, Agnieszka Wierzbowska MD, PhD1 1Department of Hematology, Medical University of Lodz, Multidisciplinary Provincial Centre of Traumatology and Oncology Nicolas Copernicus in Lodz, Łódź, Poland. 2Department of Hematology and Bone Marrow Transplantation, Heliodor Swiecicki Clinical Hospital, Poznan University of Medical Sciences, Poznań, Poland Background: Secondary acute myeloid leukemia (sAML) is associated with shorter survival compared with de novo AML and remains a challenge in hematologic oncology. Among sAML, therapy-related AML (tAML) arises from prior cytotoxic, radiation, or immunosuppressive therapy, while myelodysplastic/ myeloproliferative neoplasm-AML (MDS/MPN-AML) develops from the previous clonal disorder of hematopoiesis. Aims: To characterize MDS/MPN-AML and tAML patients, evaluate relevant prognostic factors for survival, and assess treatment outcomes. Methods: We conducted a single-center retrospective analysis of MDS/MPN-AML and tAML patients diagnosed between 20132018 in our hematology department in Lodz, Poland. Results: The study included 110 patients with MDS/MPN-AML (78) and tAML (32), median age, 66. The median follow-up was 3.2 months (95% CI:2.5–5.3). The most common hematological disorder preceding sAML was MDS (48), while the most frequent neoplasm previous to tAML was breast cancer (9). In multivariate Cox regression, age at diagnosis (95% CI:1.00–1.06), higher ECOG Performance Status score (2–4 vs 0–1) (95% CI:1.08–3.15), hypoalbuminemia (95% CI:1.95-5.24), and bone marrow blasts percentage (95% CI:1.00– 1.03) were independent predictors of poor survival. The intensive treatment was related to longer survival (95% CI:0.21–0.82). The median overall survival (OS) for MDS/MPN-AML patients was 4.1 months (95% CI:2.5–7.0) and for tAML, 2.8 months (95% CI:1.6–5.6). There were no differences in OS between MDS/MPNAML and tAML (log-rank test: P=0.86) or within particular groups: MDS-AML vs MPN-AML (P=0.21) and comparing each tAML subgroup separately (P=0.19). In patients treated intensively, the median OS was 13.9 months (95%CI:7.9–24.5), and in patients treated nonintensively, 2.5 months (95% CI:1.6–3.0) (3.3, 2.9, 1.0 months for LD-AraC, azacitidine, and best supportive care/ hydroxyurea, respectively) (P<0.0001). The allo-HSCT importance in improving survival is emphasized, although few patients (8) were eligible for the procedure and no effect was shown on significantly prolonging OS, considering the intensively treated (P=0.14). Conclusions: The prognosis for sAML is poor. Both the MDS/ MPN-AML and tAML patients showed similar characteristics and no significant differences in OS. Variables like age, ECOG score, blasts level infiltration, and albumins are independent predictors for OS. The positive influence of intensive treatment can be highlighted. Keywords: AML, therapy-related AML, secondary AML, overall survival, case AML-095 Findings From an Analysis of Patients With Monocytic and Monocytic‑Like Acute Myeloid Leukemia (AML), Including AML‑M4 and AML‑M5, Treated With Venetoclax (Ven) Plus Azacitidine (Aza) Marina Konopleva MD1, Courtney DiNardo MD2, Yan Sun PhD3, Sanam Loghavi MD4, Paul Jung PhD3, Jalaja Potluri MD3, Monique Dail PhD5, Brenda Chyla PhD3, Daniel Pollyea MD6 1Montefiore Einstein Cancer Center, New York, USA. 2The University of Texas MD Anderson Cancer Center, Houston, USA. 3AbbVie Inc, North Chicago, USA. 4The University of Texas MD Anderson Cancer Center, Houston, Houston, USA. 5Genentech Inc, South San Francisco, USA. 6School of Medicine, University of Colorado, Aurora, USA Context: In ex-vivo studies, monocytic AML (mAML) were shown to have reduced sensitivity to Ven and clinical studies suggested that M5 AML may be less sensitive to Ven+Aza. Objective: Report findings by AML differentiation status from a post-hoc analysis of Ven+Aza in intensive chemotherapy-ineligible patients. Methods: Patients from Phase Ib M14-358 (NCT02203773) and Phase III VIALE-A (NCT02993523) studies who received Ven+Aza were included. mAML was defined by investigator-assessed FrenchAmerican-British (FAB) subtyping or baseline gene expression profiling (GEP) in patients with >30% AML blasts. Expression levels of genes associated with monocytic differentiation were used to classify patients as mAML (high) or non-mAML (low). Complete remission (CR)+CR with incomplete marrow recovery (CRi) rates and median overall survival (mOS) are reported. Results: Per FAB subtyping, 32, 24, and 141 patients had M4, M5, or non-M4/M5 AML, respectively. CR+CRi rates (95% CI) were 63% (45.2−77.1) for M4, 58% (38.8-75.5) for M5, and 71% (62.9-77.8) for non-M4/ M5 AML. mOS (95% CI) was 12.4 (3.4–32.5), 16.8 (5.8–27.5), and 14.7 (10.7–22.3) months, respectively. Using GEP, 76 and 77 patients were categorized as mAML or non-mAML, respectively. CR+CRi rates (95% CI) were similar between mAML (62% [50.6–71.9]) vs non-mAML (69% [57.8–78.1]), as was mOS (14.7 [8.2–24.3] vs 15.2 [10.6–20.5] months). CR+CRi rates (95% CI) were 64% (35.4–84.8) vs 60% (48–71.5) and mOS was 46.3 vs 11.5 months for NPM1mut (n=11) vs wild-type (WT) NPM1 (n=63) mAML, respectively. In N/KRASmut (n=15) vs WT N/KRAS (n=59) mAML, CR+CRi rates (95% CI) were 33% (15.2-58.3) vs 68% (55.1-78.3) and mOS was 3.4 vs 19.4 months, respectively. In NPM1mut (n=18) vs WT NPM1 (n=56) non-mAML, CR+CRi rates (95% CI) were 72% (49.1–87.5) and 66% (53.0–77.1) and mOS was 12.5 and 14.1 months, respectively. In N/KRASmut (n=8) vs WT N/KRAS (n=66) non-mAML, CR+CRi rates (95% CI) were 75% (40.9–92.8) vs 67% (54.7–76.8), and mOS was 13 vs 14 months, respectively. Conclusion: Outcomes between patients with
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