Session: 615. Acute Myeloid Leukemia: Commercially Available Therapy, excluding Transplantation: Poster III
Hematology Disease Topics & Pathways:
Coronaviruses, AML, Diseases, Non-Biological, Therapies, chemotherapy, Pediatric, Study Population, Myeloid Malignancies, Clinically relevant
Methods: This is a retrospective multicentric trial including Brazilian children diagnosed with AML, also found to have a positive nasal and oropharyngeal PCR for SARS-Cov-2 and uniformly treated with mild induction protocol (“MAG”) that included Mitoxantrone at 5 mg/m2, by i.v. infusion over 4 to 6 hours once a day on days 1, 3, and 5 (three doses in total), Cytarabine at 10 mg/m2, subcutaneous (s.c.), q 12 h for 10 days (20 doses in total) and G-CSF 5 𝜇g/kg, s.c., once a day for 10 days (10 doses in total) [Bansal D, et al. Pediatr Blood Cancer. 2019 Nov 27:e28087].
Results: From March 15 to July 1, 2020, nine children from four different institutions were diagnosed with AML (Table 1). Their median age was 9 years (range, 5 to 18), 6 female gender, all but one diagnosed with Covid-19 by nasal PCR; one had typical chest CT and positive IgM. The institutions had previously agreed on following the same induction when treating AML children infected by the SARS-Cov-2. Five of the nine had severe illness, three of them needed mechanical ventilation and one did not need supplementary oxygen despite radiologically diagnosed pneumonia. Two children had mild symptoms and two were completely asymptomatic. All children tolerated MAG chemotherapy. Neutropenia lasted for a median of 29 days (17-33) and none of them had neither thrombotic complications nor acute renal failure. All children recovered from the Covid-19 infection and 8 of 9 already evaluable children achieved complete remission of the leukemia with MRD 0-1% after the two planned cycles. All patients are alive, on therapy.
Table 1: Patients characteristics
|Pt#||Age||Gender||AML-FAB||Molecular Biology||Cytogenetics||CNS disease||Severelly Ill||Duration of Neutropenia (days)||Response to 1st Induction||Response to 2nd Induction||COVID Symptoms||Oxygen Therapy||COVID Treatment||Status|
|1||9||M||M0||Negative||Complex karyotype with del11||No||No||33||0% blasts||MRD 0,12%||None||No||A||Alive|
|2||8||F||M2||Negative||t(10,11)||No||Yes||26||1% blasts||Too early||Inflamatory syndrome||Mechanical Ventilation||A,C,IVIG||Alive|
|3||17||F||NOS||Negative||Normal||No||Yes||22||7% blasts||MRD 1%||Pneumonia||Mechanical Ventilation||A,I,O,C,H||Alive|
|4||5||M||M4Eo||Inv16||Inv. 16||No||Yes||22||2% blasts||MRD negative||Mild||No||-||Alive|
|6||8||F||NOS||Not done||Not done||No||No||25||4% blasts||MRD negative||Pneumonia||No||A,O,C||Alive|
|7||10||F||NOS||Not done||Trisomy 22||No||Yes||17||Too early||Too early||Pneumonia, Respiratory Distress||Mechanical Ventilation||A,O,C, IVIG||Alive|
|9||18||F||M2||Negative||Not done||No||No||27||0%||MRD negative||Mild||No||A||Alive|
A - Azythromycin; I - Ivermectin; C - Corticosteroids, O - Oseltamivir; IVIG - Immunoglobulin; H- Heparin; Cipro- Coprofloxacin
Conclusions: Against all odds, MAG was well tolerated in children and adolescents newly diagnosed with AML and active Covid-19, with no treatment-related mortality. All evaluable patients achieved remission and are currently proceeding therapy. The high prevalence of Covid-19 in our country may have to be taken into account in all oncological treatment strategies. With a shorter duration of neutropenia, the absence of mucositis or invasive fungal infections, MAG may be implemented in low- and middle-income countries as an optimal strategy to overcome induction mortality and improve outcome of children and adolescents with AML.
Disclosures: No relevant conflicts of interest to declare.
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