Outcomes following induction chemotherapy in patients with AML arising from MDS: Analysis of prognostic factors

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7088 Background: Secondary acute myeloid leukemia (sAML) arising from myelodysplasia (MDS) or a myeloproliferative neoplasm (MPN) has a poor prognosis. To date, there is limited knowledge about risk factors that determine how sAML will respond to treatment. This analysis evaluated possible prognostic factors in patients with sAML that were treated with anthracycline-based induction therapy. Methods: Retrospective chart review of patients with untreated AML from MDS/MPN treated with standard induction therapy from January 2004 to September 2008. Age, IPSS, ECOG PS, cytogenetics, duration of MDS, and prior MDS treatment were evaluated for their impact on obtaining complete remission (CR) or CR with low platelets (CRp) and overall survival (OS). Results: Sixty-one patients with sAML who received induction therapy were evaluated: median age (range) = 66 (36–82) years; M = 67%, ECOG PS 0 or 1 = 86%; poor-risk (PR) cytogenetics = 33%; IPSS > 1 = 43%; prior therapy for MDS with decitabine or azacitidine (DM) or lenalidomide (L) = 41% (25 pts). Of the entire group, 59% (36 pts) achieved CR/CRp (95% CI: 46%-71%) and the median OS was 6.5 (95% CI: 3.9–8.1) mo. Multivariable analysis indicated that the same three factors were significantly negatively associated with CR/CRp as well as OS: PR cytogenetics, prior treatment with DM/L, and long transformation to AML on log scale. Only 32% of the group that received prior treatment with a DM/L achieved CR/CRp compared to 78% in non DM/L-treated patients (OR = 0.13, 95% CI: 0.04–0.42). The CR/CRp rate for those with intermediate risk (IR) cytogenetics was 70% compared to only 35% for those with PR cytogenetics (OR = 4.33, 95% CI: 1.38–13.6). Those with PR cytogenetics had a median OS of 2.8 mo compared to 7.5 mo for IR (p = 0.01). The median OS for those treated with a DM/L was 3.7 mo compared to 10.5 mo for non DM/L-treated patients (p < 0.0001). Conclusions: Prior MDS treatment with a DM/L, PR cytogenetics and long transformation to AML are independent negative prognostic factors for response and OS in patients with sAML following induction therapy, suggesting that such patients may be better served by novel approaches, and that stratification for these risk factors should be considered in future clinical trials. Larger-scale confirmation of these data is ongoing. No significant financial relationships to disclose.