AML-085 Real-World Treatment Patterns and Clinical Outcomes in Romanian Patients With AML Unfit for First-Line Intensive Chemotherapy

Abstract

Acute myeloid leukemia (AML) predominantly affects the elderly, and prognosis declines with age. Induction chemotherapy plus consolidation therapy is the standard of care for fit patients; options for unfit patients include hypomethylating agents (HMA), low dose cytarabine (LDAC), targeted therapies, and best supportive care (BSC). This retrospective chart review evaluated clinical outcomes in unfit Romanian patients with AML who initiated first-line treatment or BSC 01/01/2015-12/31/2018. Overall survival (OS), progression-free survival (PFS), time-to-treatment failure (TTF), and response rates were assessed. Of 98 patients, 84 (85.7%) received systemic therapies: HMA, LDAC, and other therapies; 14 (14.3%) received BSC. Median OS at the time of data collection was 8.6 months, significantly lower in the BSC group (3.4 months) than in those who received an HMA as a first line systemic therapy (FLST) (10.0 months). The most frequent cause of death was AML progression, infection, and other comorbid conditions in the FLST group and AML progression in the BSC group. Median PFS was 6.0 months, significantly longer in those who received an HMA as FLST than in those who received other types of therapies (8.0 months in those who received HMA vs. 6.4 months in LDCA vs. 3.4 in the BSC group). Median TTF was significantly longer in the BSC group (3.6 months) as compared to the systemic therapy group (2.1 months in those who received HMAs, 0.4 months in those who received LDCA, and 1.0 months in those who received other systemic therapies). The best overall response in the FLST group was stable disease in 20.2% of the patients, partial remission (PR), and progressive disease (PD) in 9.5% of the patients, and complete remission (CR) in 8.3% of the patients, with a median time from the start of treatment to the best response of 110.5 days. Our findings highlight the unmet need for novel therapies for unfit patients.