Abstracts Clinical Lymphoma, Myeloma & Leukemia September 2023 S278 pregnant AL patients treated at Memorial Hermann Hospital, Texas Medical Center, between January 1, 2015, and December 31, 2022. Setting: General community, academic hospital setting. Patients or Other Participants: Pregnant AL patients. Main Outcome Measures: Maternal and fetal outcomes. Results: We identified 6 pregnant AL patients: acute promyelocytic leukemia (APL)=1, core binding factor acute myeloid leukemia (AML)=2, acute lymphoblastic leukemia (ALL)=3 (T-cell lymphoblastic leukemia [ATL]=2, BCR-ABL-negative B-ALL=1). The median age was 24.5 (range, 21–31) years. Subject races were 1 White, 1 Asian, 3 African American, and 1 Hispanic. The APL patient presented with intracranial hemorrhage at 25 weeks gestation and died within 48 hours of admission. A cesarean section was performed, but the fetus was dead. The ATL patient, diagnosed at 12 weeks, received induction chemotherapy (IC) with hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD A), and achieved a complete response (CR). She delivered at 32 weeks but died from relapsed ATL 10 months after diagnosis. The second ATL patient, diagnosed at 32 weeks, started IC with hyper-CVAD A 72 hours after cesarean section, achieving a CR. The B-ALL patient was diagnosed at 22 weeks and had refractory disease after one cycle of hyper-CVAD A. She received blinatumomab salvage therapy and remains in CR. One AML patient, diagnosed at 32 weeks, underwent cesarean section, and started IC 72 hours later with fludarabine, cytarabine, and idarubicin, achieving a CR, but died from septic shock 8 months after diagnosis. The second AML patient, diagnosed at 17 weeks, received fludarabine, cytarabine, and gemtuzumab ozogamicin, achieved a CR, and delivered at 34 weeks. Four of the six women are currently alive and leukemia-free. Five of the six children are alive. Conclusion: Treating AL during pregnancy is challenging; a multidisciplinary team of maternal-fetal medicine and malignant hematology specialists is critical to improve outcomes. Standard leukemia IC regimens can be safely administered during the second or third trimester of pregnancy. Keywords: AML, pregnancy, pregnancy and cancer, induction chemotherapy AML-212 Clinical Outcomes of Patients With Acute Myeloid Leukemia (AML) Requiring Intensive Care Unit (ICU) Admission During Induction Therapy: Single‑Institution Retrospective Study Binoy Yohannan MD, Kok Hoe Chan MD, Arthi Sridhar MD, Frances Cervoni-Curet MD, Adan Rios MD Division of Hematology/Oncology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, USA Context: Induction chemotherapy (IC) in AML is associated with significant morbidity and mortality. Despite best supportive care, patients with AML requiring ICU admission during IC have a markedly reduced short-term survival. Objective: Analyze outcomes of patients with AML requiring ICU admission at our institution. Design: Single-center retrospective study. Setting: General community, academic hospital setting. Patients or Other Participants: Adults with AML undergoing IC. Main Outcome Measures: ICU mortality and median overall survival (OS). Results: Among 94 patients with AML, 19 (20%) required ICU admission, 10 (52%) of whom were women. The median age was 73 (range, 18–84) years. Four (21%) patients had favorable-risk, 4 (21%) had intermediate-risk, and 11 (58%) had adverse-risk disease per European Leukemia Network guidelines. Young and fit patients with AML (n=52) received fludarabine/cladribine, idarubicin, and cytarabine (FIA/CLIA); unfit patients received either hypomethylating agents with or without venetoclax (HMA±Ven) (n=33) or cladribine (CLAD), low-dose cytarabine (LDAC), and Ven (n=9). Among 52 AML patients treated with FIA/CLIA, 14 (26.9%) required ICU admission. In contrast, 4 (12%) patients treated with HMA±Ven and 1 (11%) patient treated with CLAD/ LDAC plus Ven required ICU admission (P=0.16). The most common indication for ICU admission was respiratory failure (n=11, 58%), followed by bacteremia and sepsis (n=10, 52%). Nine (47%) patients required mechanical ventilation, and 8 (42%) developed acute kidney injury, with 4 (21%) requiring dialysis support. The ICU mortality rate was 37% (n=7); sepsis (n=5, 26%) was the leading cause of death. One patient each died from hemorrhagic pericardial effusion and intracranial bleed. Overall, 12 (63.1%) patients survived to discharge. The 3-month and 6-month OS in the entire cohort was 57% and 31%, respectively. Among patients with favorable-risk AML, the median OS was 34 months versus only 3 months in the adverse-risk group (P=0.06). Conclusion: Patients with adverse-risk AML requiring ICU admission during IC tend to have a poor prognosis. With aggressive supportive care, all patients with favorable-risk AML who survived the ICU admission were able to resume leukemia therapy and had favorable long-term outcomes. Keywords: AML, induction chemotherapy, ICU admission, mortality AML-219 Multi‑Gene Molecular MRD by Digital PCR is Prognostic of Outcomes in AML Treated With Venetoclax/Azacitidine Amanda Winters MD, PhD1,2, Mohd Minhajuddin PhD3, Brett Stevens PhD3, Ajay Major MD, MBA3, Nicholas Miltgen B.S.4, Ji Yuan PhD3, Amy Treece MD5, John Gutman MD3, Craig Jordan PhD3, Daniel Pollyea MD, MBA3 1University of Colorado, Aurora, USA. 2Children’s Hospital Colorado, Aurora, USA. 3Division of Hematology, Department of Medicine, University of Colorado, Aurora, USA. 4Department of Molecular Diagnostics, Children’s Hospital Colorado, Aurora, USA. 5Children’s Hospital Alabama, Birmingham, USA Context: Measurable residual disease (MRD) is the most important post-treatment predictor of relapse in acute myeloid leukemia (AML). However, molecular MRD is less well validated than flow MRD with respect to prognostic import, particularly after low-intensity therapies like venetoclax/azacitidine (ven/aza). Objective: To test the hypothesis that multi-gene molecular MRD, quantified by droplet digital polymerase chain reaction (ddPCR), is predictive of outcomes in patients with AML receiving ven/aza. Our
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