ASH 2009 meeting report—Top 10 clinically oriented abstracts in acute leukemia

Abstract

summary Acute myelogenous leukemia (AML) associated with core binding factor (CBF) abnormalities is sensitive to high-dose cytarabine-based chemotherapy leading to complete remission (CR) in over 90% of patients. The efficacy of cytarabine can be enhanced by the addition of fludarabine and GCSF with report of improved event free survival with this regimen [1]. Inclusion of gemtuzumab ozogamicin (GO) to induction chemotherapy produces favorable outcomes without additional toxicity [2]. Thirty-four patients with CBF AML were treated with induction/consolidation chemotherapy consisting of GO-FLAG. Of 29 patients not in CR at the time of initiation of therapy, all but two patients achieved CR or CR with incomplete platelet recovery. A sustainable more than three-log reduction in fusion transcript to ABL ratio from the median pretreatment value remained evident through follow-up at 9 months. Two patients died during induction therapy. The most common grade 3/4 toxicity was liver dysfunction in three patients. Additional toxicity reported included atrial fibrillation, pancreatitis, and respiratory failure. Discussion Despite repeated cycles of cytarabine-based chemotherapy, the relapse free survival of CBF AML decreases over time. Therapy sustaining clinical, as well as molecular remissions is vital to improving overall survival. The addition of GO to AML induction chemotherapy improved outcomes in CBF AML without additional toxicity. 2. Decitabine-Based Salvage Therapy in Adults with Acute Myeloid Leukemia (#2063) Abstract summary Poor response to salvage chemotherapy is common in relapsed AML,summary Poor response to salvage chemotherapy is common in relapsed AML, however the achievement of CR, specifically after second salvage therapy, may not correlate with survival benefits [3]. Low intensity options have been recognized to prolong survival in relapsed or refractory AML without significant toxicity. Medical records of patients aged 24–89 years (median 65.5 years) who received decitabine-based chemotherapy from September 2006 through July 2009 were reviewed. Twenty-nine patients received decitabine 20 mg/m daily for 10 days while 51 patients were treated with decitabine 20 mg/m daily for 5 days in combination with gemtuzumab 3 mg/ m on day 5. Median survival and CR rate reported in first salvage (n 5 25), was 181 days and 13%, second salvage (n 5 32) 207 days and 9%, and third or greater salvage (n 5 22) 209 days and 23%. The difference in survival between those patients receiving single agent decitabine versus decitabine in combination with gemtuzumab was not significant (209 days decitabine versus 177 days decitabine-gemtuzumab). Significant survival benefits were evident for those patients with normal and favorable cytoge-