Program: Oral and Poster Abstracts
Session: 613. Acute Myeloid Leukemia: Clinical Studies: Poster I
Aims: The aim of the study was to assessed clinical characteristics and treatment outcome of patients with AML and the CNSi who were treated between 2004 and 2014 in 8 hematology departments of the Polish Adult Leukemia Group (PALG).
Results: The analysis comprised 65 patients (62% males and 38% females) with the median age of 45 years (range 20-81 years). The CNSi was observed in 33 (51%) patients at the time of AML diagnosis (group 1) and in 32 (49%) subjects during the course of AML (group 2).
The most common neurological symptoms were headaches (47% vs 48%, p= 0.99) and altered mental status (21% vs 30%, p= 0.32) observed in the group 1 and 2, respectively. Higher rates of paraparesis (39% vs 9%, p= 0.002) and motor deficits (33% vs 9%, p= 0.011) were noted in the group 2 compared to the group 1.
The CNSi was the most frequently found in the AML not otherwise specified (AML NOS) subtype (61% in the group 1 and 50% in the group 2; p= 0.39). The AML subtype with recurrent cytogenetic abnormalities was diagnosed in 30% of patients form the group 1 and 28% of subjects from the group 2 (p= 0.85). The therapy and dysplasia related AML subtype was diagnosed in 6% of patients from the group 1 compared to the 16% of patients from the group 2 (p= 0.21). Using the FAB classification of AML, the CNSi in the group 1 occurred more often among patients with the M4 (42%) and the M5 (30%) subtype, whilst in the group 2 it was found in the M2 (25%) and the M5 (22%) subtype. The cytogenetic risk distribution according to the SWOG (ie. favorable, intermediate and poor) were 13%, 28% and 16% in the group 1 and 18%, 15% and 21 % in the group 2, respectively (p=0,39). The group 1 was more likely to have abnormal cytogenetics involving the chromosome 8 or 16 compared to the group 2 (62% vs 27%, p= 0.012).
After the diagnosis of the CNSi, systemic chemotherapy was administered to 100% of patients from the group 1 and to 80% of patients from the group 2. Intrathecal chemotherapy was administered to 94% patients in both groups, whereas 19% of patients were subjected to subsequent brain radiation therapy. The cytarabine with methotrexate with corticosteroid was given intrathecally to 83% of patients, whilst the cytarabine monotherapy, the methotrexate with or without corticosteroid and liposomal cytarabine were given intrathecally to 1.5%, 9.1% and 18.2% patients, respectively. The CNS remission rate was higher in the group 1 compared to the group 2 (72% vs 39%, p= 0,003).
Allo-HSCT in the first complete remission (CR1) as well as allo-HSCT after the AML relapse were performed with similar frequency in the both groups (21% vs 25%; p= 0.72 and 12% vs. 16%; p=0.73, respectively).
The probability of a 1-year overall survival (OS) between the group 1 and 2 was not significantly different (52% vs 58% , p= 0.8). However, the OS rate was significantly higher in patients who underwent allo-HSCT in their CR1 compared to that in the patients without allo-HSCT (94% vs 39%; p<0.001). It is worth noting that the OS rate was also higher when more consolidation courses were given before allo-HSCT (17% vs 67% vs 83% ; p<0.001 for 0-1 vs 2-3 vs 4 courses, respectively).
Conclusions: The cytogenetic profile seems to be a key difference in patients’ characteristics with the CNSi at the time of diagnosis or during the course of AML, with the chromosome 8 or 16 aberrations observed more often in the former group. The survival of AML patients with CNSi was short with the 1-year OS rate below 60%. However, the OS rate was significantly improved in those patients who underwent allo-HSCT in their CR1.
Disclosures: No relevant conflicts of interest to declare.
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