613. Acute Myeloid Leukemia: Clinical Studies: Intensive Upfront Chemotherapy
Jorge Sierra, Ana Garrido, Marina Diaz Beya, Montserrat Hoyos, et al.
Conclusion cited from the abstract: Risk adapted therapy for primary AML based on genetics and MRD is feasible in a cooperative group setting. The proportion of CR was high (>80%) even in patients older than 60 y/o. MRD assessment at the end of consolidation moved 57 patients with favorable or intermediate genetics to the CAG. Avoiding HCT in first CR in the FGC patients associated to EFS above 75% at 4 years. Allogeneic transplantation feasibility was 80% when this was the intended treatment because of adverse genetics and/or MRD positivity. Risk assessment based on genetics and MRD continues separating three groups of patients with different outcomes. Since relapses remain frequent when adverse AML features are present, further approaches after transplantation, such as targeted agents and immune therapies deserve investigation.
Gautam M. Borthakur, Jorge E. Cortes, Farhad Ravandi, Guillermo Garcia-Manero, et al.
Conclusion cited from the abstract: FLAG-GO or FLAG-Ida regimen results in high remission rates among patients with newly diagnosed patients with CBF-AML with low induction mortalities. Induction consolidation with FLAG-GO results in better RFS and quantitative reduction in fusion transcript ratio, compared to FLAG-Ida. Serial quantitative monitoring of fusion transcript identifies patients with better chances of sustained remission.
Megan Othus, Guillermo Garcia-Manero, John E. Godwin, James K. Weick, et al.
Conclusion cited from the abstract: Both length of CR1 and survival after relapse have increased over the last four decades in patients age 65 or younger even after accounting for differences in patient characteristics. Possible explanations for the longer survival after relapse include higher 2ndCR rates, more frequent use of hematopoietic cell transplant in CR, or better supportive care. Regardless, the longer survival after relapse suggests analyses of event-free survival should complement those of overall survival when evaluating new treatments in AML.
Jessica A. Pollard, Todd A. Alonzo, Patrick A. Brown, Robert B. Gerbing, et al.
Conclusion cited from the abstract: Addition of sorafenib to Arm C of AAML1031 was safe and resulted in potent FLT3 inhibition, particularly early in therapy. Sorafenib improved rates of induction II CR as well as 3 year EFS and reduced RR from CR compared to historical controls. These data support use of sorafenib in pediatric patients with HAR FLT3/ITD+ AML.
Mareike Rasche, Emma Steidel, Denise Kondryn, Nils Von Neuhoff, et al.
Conclusion cited from the abstract: This analysis indicates the benefit of risk-adapted indications for HSCT in pediatric AML: After a long period with a stable pEFS (Rasche et al. Leukemia 2018) the current cohort now demonstrates a significant improvement. The efficacy of the risk-adapted approach is reflected by remarkable survival rates for patients with HR AML. At the same time, it seems not to impair the ongoing improvement of salvage therapy. However, for patients with poorly responding IR AML the outcome is dismal despite HSCT and they require alternative treatment approaches. Further studies are also needed to detect genetically defined HR patients who may not need HSCT, but also to develop efficient re-stratification approaches to enhance the survival in SR patients.
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Xinxin Cao, Jian Li, Ai-lin Zhao, Xue-min Gao, et al.
Conclusion cited from the abstract: Methotrexate and cytarabine is an efficient and safe regimen for newly diagnosed adult LCH. The involvement of liver at baseline indicates a worse prognosis in adult LCH.