Abstracts Clinical Lymphoma, Myeloma & Leukemia September 2023 S290 AML-324 Impact of Discharge Timing for Extended‑Course Decitabine and Venetoclax in Acute Myeloid Leukemia (AML) Arash Velayati MD, MBA, Julie Dickerson MD, PhD candidate, Kevin Graf MD, Justin Kusiel MD, Kimberly Green MD, Praneeth Baratam MD, Alexander Coltoff MD Medical University of South Carolina, Charleston, USA Context: A recent single-arm study of older AML patients showed that 10-day decitabine plus venetoclax (DEC-10/VEN) resulted in complete remission (CR)/complete remission with incomplete count (CRi) rate of 89%, minimal residual disease (MRD)-negative CR rate of 67% and a median survival (OS) of 18 months, in newly diagnosed patients. Despite promising outcomes, there is concern that the DEC-10 course may cause more profound cytopenias, increased infections, and prolonged hospitalizations, which may offset improved efficacy. At our institution, patients are often hospitalized for DEC-10/VEN with a planned discharge after the last dose of decitabine. Objective: To study the outcomes of patients with prolonged hospitalization (stay beyond a 10-day treatment course) and compare adverse events (including infections, 30-day mortality, and readmission rates) and response rates, PFS, and OS. Design: Retrospective chart review. Setting: Tertiary-care hospital in the Southeast United States. Patients: Seventy-seven patients with AML who received their first cycle of DEC-10/VEN while admitted. Main Outcome Measures: Response rate, PFS, and OS in the patient group with prolonged hospitalization compared to non-prolonged hospitalization. Other measures included rates of infection, 30-day mortality, and 30-day readmission rates. Results: Most patients (60%) who received DEC-10/VEN required prolonged hospitalization with an average length of stay of 19.5 days. Infection rates were higher in patients needing prolonged hospitalization (47% vs 10%, P=0.00001). No difference in response rate (CR/CRi) (63% vs 58%, P=0.64), 30-day mortality rates (8.5% vs 6.8%, P=0.79), or 30-day re-admission rates (46.8% vs 44.8%, P=0.73) were observed in prolonged vs non-prolonged hospitalizations respectively. A trend toward shorter PFS (median, 9.3 vs 21.6 months, P=0.31) and OS (median, 22.8 vs 31 months, P=0.5) was noted with prolonged hospitalization, though it was not statistically significant. Conclusions: Prolonged hospitalization was common with DEC-10/VEN and was associated with increased infections but did not impact treatment outcomes or survival. Keywords: AML, acute Myeloid Leukemia, hypomethylating agent, venetoclax, hospitalization outcome AML-325 The Efficacy of Anti‑Thymocyte Globulin for in Vivo T Cell Depletion in Conditioning in Patients With Acute Myeloid Leukemia Undergoing Allogeneic Hematopoietic Stem Cell Transplantation From Related and Unrelated Donors Lazar Chadievski MD, Aleksandra Pivkova Veljanovska PhD, Simona Stojanovska MD, Milche Cvetanovski MD, Nevenka Ridova MD, Bozidar Kocoski MD, Sanja Trajkova PhD, Marija Popova Labachevska MD, Lidija Chevreska PhD, Borche Georgievski PhD, Irina Panovska Stavridis PhD University Clinic for Hematology, Skopje, Macedonia, the former Yugoslav Republic of Context: Allogeneic hematopoietic stem cell transplant (HSCT) is the treatment with the biggest curative potential in patients with AML. Up to 70% of patients undergoing allogeneic HSCT will suffer graft versus host disease (GvHD) to some extent, significantly contributing to the mortality rates. Objective: One possibility for GvHD prophylaxis is in vivo T cell depletion with anti-thymocyte globulin (ATG) during conditioning. The major drawback is the fear of increased rates of infections and worsened relapse rates. Design: We made a comparative analysis of patients conditioned with ATG and without ATG Setting: Patients with AML undergoing allogeneic HSCT form matched related and unrelated donors. Patients: We analyzed 40 patients with AML from 2014 to 2021 who underwent allogeneic HSCT. The posttransplant immunosuppression was standard with calcineurin inhibitors (CNI) + methotrexate for myeloablative conditioning, and cyclosporin A + mycophenolate mofetil for reduced-intensity conditioning. Interventions: ATG -thymoglobuline at 5 to 10 mg/kg was administered on days 3, 2, and 1 before transplant. Main Outcome Measures: We made a comparative analysis of the GvHD rates, infection rates, and relapse rates in patients with and without ATG in conditioning. Results: In the ATG group, 15.8% had acute GvHD, 10% had grades III-IV, and the same percentage had chronic GvHD. The non-ATG group had significantly higher rates of acute GvHD (29%) and chronic GvHD (24%) and higher rates (19%) of acute GvHD grades III-IV. No inferiority was confirmed regarding fatal infection rates in the ATG group compared with the non-ATG group. The same accounts for the relapse rates (in the non-ATG group, 19%) compared to the ATG group (16%). There was no significant difference in the overall survival in these 2 groups of patients. Conclusions: Using ATG in the conditioning of patients with AML undergoing allogeneic HSCT for in vivo T-cell depletion is justified as it leads to lower rates of GvHD and better quality of life without worsening relapse rates while maintaining the curative potential of allogeneic HSCT. Keywords: AML, GvHD, allogeneic HSCT, ATG
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