Abstracts Clinical Lymphoma, Myeloma & Leukemia September 2023 S282 Aims: We studied a series of patients with APL-like NPM1+ AML, focusing on the incidence of vascular events at onset, and investigated the impact of some markers reported to correlate with coagulopathy. Methods: Patients diagnosed with NPM1+ AML at our Centre according to conventional criteria from March 2011 to January 2023 were included in the study. APL-like definition relied on negativity for CD34 and HLA-DR. Results: Of a total of 123 patients with NPM1+ AML, 28 (22.77%) were defined as APL-like. They were older (64 y) than non-APL-like (56 y, P=0.003) patients. Vascular complications were significantly more frequent in the APL-like (n=9, 33.3%) than non-APL-like (n=13, 14.4%, P=.046) group. D-dimer was significantly higher in APL-like (median 7,499 ng/ml) than non-APL-like (2,319 ng/ml, P=.001) patients. Also, D-dimer/fibrinogen ratio (DD/FBG), a predictor of vascular events, showed higher level in APL-like (median 21.28) than non-APLlike (4.62, P=.003) patients. Furthermore, among patients with vascular complications higher levels were found in the APL-like group (median 349.28 vs 18.82, P=.013). In multivariate analysis, the impact of APL-like phenotype maintained an independent value (OR=2.77, P=.041) from age (OR=1.01, P=.61). The analysis of molecular data demonstrated a significant enrichment in both IDH1 (P=.001) and IDH2 (P=.02) in APL-like patients. As regards outcome, complete remission rate was 85.7% and 78.9% in APL- and non-APL-like (P=.43). We did not observe any significant difference between APL- and non-APL-like patients in diseasefree (13.2 vs 22.0 months; P=.83) or overall (15.9 vs 15.1 months, respectively; P=.57) survival. Conclusions: Our findings suggest APL-like signature to be a potential predictor of susceptibility to vascular events within NPM1-mutated AML. Our results deserve validation in a larger patient set and might indicate the utility of intensive monitoring and supportive care to prevent early vascular events in this patient category. Keywords: AML, acute myeloid leukemia, NPM1, vascular complication, coagulopathy AML-257 Hemostatic Aberrations in Adult Patients With Acute Leukemia: A Single Center Experience Sarah Alnuaimy MSc1, Rawand Shamoon PhD2 1Nanakali Hospital for Blood Diseases and Cancer, Erbil, Iraq. 2Hawler Medical University/ College of Medicine, Erbil, Iraq Context: Acute leukemia (AL) patients are at high risk for bleeding and thrombotic events due to the disruption of the normal hemostatic system associated with this disease. Objective: To assess the hemostatic parameters in patients with newly diagnosed AL at the time of presentation. Design: This prospective crosssectional study was conducted between September 2021 and May 2022. Setting: The study was conducted at Nanakali Hospital for Blood Diseases and Cancer in Erbil City/Iraq. Patients: This study included 59 patients with de novo acute leukemia and 35 age- and gender-matched control subjects. The diagnosis of AL was based on clinical and morphological findings of peripheral blood, bone marrow aspirates, and biopsies. Classification of AL was done using flow cytometry. The included patients had confirmed diagnosis of de novo AL (acute myeloid leukemia [AML] and acute lymphoblastic leukemia [ALL]), they were ≥ 15 years of age with no history of a bleeding tendency or thrombophilia, no organ failure, and did not receive any form of supportive or definite therapy before sample withdrawal. Pregnant patients were not included in this study. Interventions: Coagulation markers, including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen level (FBG), D-dimer (D-Di), antithrombin (AT), protein C (PC), and protein S (PS) were measured for each patient and control. Results: The median age of the patients was 41 years, with a maleto-female ratio of 1.1:1. Thirty-eight (64.4%) patients had AML, and 21 (35.6%) patients had ALL. D-Di levels were significantly raised in both AML and ALL compared to controls. PT was significantly higher, and PC and AT were significantly lower in AML than ALL or control groups. The bleeding incidence in AML was significantly higher than in ALL (65.8% versus 23.8%), and the highest incidence of bleeding was in APL (100%). Risk factors for bleeding were thrombocytopenia (moderate and marked), AML type, and leukocytosis (>20×109/L). Thrombosis occurred in 2 (3.4%) patients. Conclusions: Coagulation abnormalities are common in AL. Hemostatic derangement and bleeding at the time of presentation were more pronounced in patients with AML than ALL. Keywords: AML, acute leukemia, bleeding, hemostatic derangement AML-260 A Metabolically Optimized, Non‑Cytotoxic Low‑Dose Weekly Decitabine/Venetoclax Regimen in MDS and AML David Levitz MD, Kate Fedorov MD, Mendel Goldfinger MD Monterfiore Medical Center, NYC, USA Venetoclax (VEN) added to the hypomethylating agents (HMA) decitabine or azacitidine is both the new standard of care for elderly patients with acute myeloid leukemia (AML) and is increasingly being used for patients with myelodysplastic syndrome (MDS). Current dosing of HMA/VEN relies on leukemia suppression through cytotoxicity, which also impacts normal hematopoiesis. A onceweekly low-dose decitabine regimen (LDDec) has demonstrated activity in myeloid malignancies by depleting the epigenetic regulator DNA methyltransferase 1 (DNMT1). Prolonged doses of VEN cause myelosuppression, and the minimum dose of VEN needed to synergize with HMA is not yet known. We evaluated adding a once-weekly dose of VEN to LDDec in elderly and/or frail patients with poor marrow reserve who felt less likely to tolerate severe myelosuppression. In a retrospective cohort of 39 patients, the ORR for patients receiving LDDec/VEN for frontline AML and MDS was 88% and 64%, respectively. In patients with TP53 mutations, the CR/CRi rate was 71%, and the median OS was 10.7 months. When compared to a cohort of 36 patients receiving standard dosing of HMA/VEN, the LDDec/VEN patients had a significantly longer time on therapy (175 vs 78 days; P=0.014) and a numerical trend toward a higher rate of transfusion independence (47% vs
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