Session: 637. Myelodysplastic Syndromes – Clinical and Epidemiological: Poster II
Hematology Disease Topics & Pathways:
Research, epidemiology, Clinical Research, Chronic Myeloid Malignancies, CMML, Diseases, real-world evidence, Myeloid Malignancies
Methods: We retrospective evaluated a cohort of patients diagnosed with CMML from 2005 to 2022. Data regarding previous exposure to treatment was captured and tCMML diagnosis was established for patients with a documented prior history of radiation therapy or cytotoxic chemotherapy due to an antecedent malignancy prior to the diagnosis of CMML. Those non-tCMML were defined as de novo CMML (dnCMML). Overall survival (OS) was calculated from diagnosis to death, and leukemia-free survival (LFS) was calculated from diagnosis to death or AML transformation.
Results: A total of 532 patients with CMML were included in the study, of whom 71 (13%) were tCMML. When comparing tCMML with dnCMML, there were no differences in median age (73 vs 70 years old) or sex (67% vs 69% male). No differences were noted in white blood cell count, absolute monocyte count, hemoglobin or platelet count. According to the WHO 2016 classification, 38% vs 44% were CMML-0, 40% vs 36% were CMML-1, and 22% vs 20% were CMML-2, for patients with dnCMML and tCMML, respectively. According to the FAB classification, 42% vs 52% were dysplastic and 58% vs 49% were proliferative, for patients with dnCMML and tCMML, respectively. Chromosome 7 abnormalities where more common among tCMML compared to dnCMML (14% vs 4%, p=0.006), with no differences in frequency of complex karyotype (8% vs 3%, p=0.1).
In tCMML patients, 35% received only radiotherapy, 31% only chemotherapy and 34% both. In patients that received chemotherapy, the most common therapies were alkylating agents (45%), agents targeting microtubules (37%) and antimetabolite agents (35%). The median latency from therapy to tCMML was 6.5 years (range, 0.1-24). Most common neoplasms prior to the diagnosis of tCMML were prostate (25%), lymphoma (23%) and breast cancer (14%).
Most frequently detected mutations at diagnosis were TET2 (55% vs 61%, p=0.5), ASXL1 (44% vs 53%, p=0.3), and SRSF2 (43% vs 30%, p=0.1), in patients with dnCMML and tCMML, respectively. Patients with tCMML had a lower incidence of NRAS (22% vs 6%, p=0.007) and CBL (18% vs 5%, p=0.04) mutations compared to dnCMML, but these mutations were present at a higher median VAF among patients with tCMML (48% vs 18% [p=0.04] for NRAS and 91% vs 20% [p=0.02] for CBL) (Figure 1). TP53 mutations were more frequent in the tCMML although differences were not significant (12% vs 4%, p=0.06).
Among all patients, 352 patients received treatment and were evaluable for response (305 patients with dnCMML and 47 patients with tCMML). More than 90% of patients received an hypomethylating agent-based therapy, with an ORR of 59% for dnCMML and 60% for tCMML.
The median follow-up was 58 months, and the median OS and LFS for the entire cohort were 36 and 29 months, respectively. No differences in OS (36 vs 35 months, p=0.3) or LFS (29 vs 28 months, p=0.8) were observed between dnCMML and tCMML, However, when comparing by risk groups according to CPSS-Mol, patients with tCMML classified as intermediate-1 (Int-1) risk had a significant lower OS (38 vs 88 months, p=0.02) and LFS (38 vs 85 months, p=0.03), compared to Int-1 dnCMML (Figure 2). In a multivariate model for OS including CPSS-mol, tCMML stratified by type of therapy and age, patients with tCMML with a previous exposure to chemotherapy had a hazard ratio of 1.76 (1.07-2.89, p=0.03).
Conclusion: Patients with tCMML have a higher proportion of chromosome 7 abnormalities and a lower incidence of NRAS and CBL mutations. Although responses to HMA were similar, patients with tCMML with a previous exposure to chemotherapy are associated with a lower survival, especially patients classified as CPSS-Mol intermediate-1.
Disclosures: Chien: Rigel Pharmaceuticals: Consultancy; AbbVie: Consultancy. DiNardo: Fogham: Honoraria; ImmuniOnc: Honoraria; AbbVie/Genentech: Honoraria; Astellas: Honoraria; BMS: Honoraria; Notable Labs: Honoraria; Servier: Honoraria; Novartis: Honoraria; Takeda: Honoraria; Schrödinger: Consultancy. Ravandi: Prelude: Research Funding; Abbvie: Consultancy, Honoraria, Research Funding; Astellas: Consultancy, Honoraria, Research Funding; Celgene/BMS: Consultancy, Honoraria, Research Funding; Biomea fusion: Honoraria, Research Funding; Syros: Consultancy, Honoraria, Research Funding; Xencor: Research Funding; Amgen: Honoraria, Research Funding; Astex/taiho: Membership on an entity's Board of Directors or advisory committees, Research Funding. Borthakur: Astex Pharmaceuticals, Ryvu, PTC Therapeutics: Research Funding; Catamaran Bio, Abbvie, PPD Development, Protagonist Therapeutics, Janssen: Consultancy; Pacylex, Novartis, Cytomx, Bio Ascend:: Membership on an entity's Board of Directors or advisory committees. Kadia: Genentech: Consultancy, Research Funding; GenFleet Therapeutics: Research Funding; Glycomimetics: Research Funding; Cellenkos Inc.: Research Funding; Amgen, Inc.: Research Funding; Janssen Research and Development: Research Funding; Cyclacel: Research Funding; Celgene: Research Funding; Novartis: Consultancy; Liberum: Consultancy; Cure: Speakers Bureau; Iterion: Research Funding; Delta-Fly Pharma, Inc.: Research Funding; Hikma Pharmaceuticals: Speakers Bureau; AstraZeneca: Research Funding; Astellas Pharma Global Development: Research Funding; Ascentage Pharma Group: Research Funding; Jazz Pharmaceuticals, Pfizer, Pulmotect, Inc, Regeneron Pharmaceuticals, SELLAS Life Sciences Group: Research Funding; Biologix, Cure, Hikma Pharmaceuticals: Speakers Bureau; Genzyme: Honoraria; AbbVie, Amgen, Inc, Ascentage Pharma Group, Astellas Pharma Global Development, Astex, AstraZeneca, BMS, Celgene, Cellenkos Inc, Cyclacel, Delta-Fly Pharma, Inc, Genentech, Inc., Genfleet, Glycomimetics, Iterion, Janssen Research and Development: Research Funding; Agios: Consultancy; Daiichi Sankyo, Genentech, Inc., Genzyme, Jazz Pharmaceuticals, Liberum, Novartis, Pfizer, PinotBio, Inc, Pulmotect, Inc, Sanofi-Aventis, Servier: Consultancy; Servier: Consultancy; Pinotb-Bio: Consultancy; BMS: Consultancy, Research Funding; Sanofi-Aventis: Consultancy; Regeneron Pharmaceuticals: Research Funding; Pfizer: Consultancy, Research Funding; Pulmotect, Inc.: Consultancy, Research Funding; SELLAS Life Sciences Group: Research Funding; Astex: Honoraria. Kantarjian: Pfizer: Honoraria; Novartis: Honoraria; KAHR Medical: Honoraria; Jazz Pharmaceuticals (Inst): Honoraria, Research Funding; Ipsen: Honoraria; Immunogen (Inst): Honoraria, Research Funding; Daiichih-Sankyo (Inst): Honoraria, Research Funding; AstraZeneca/MedImmune: Honoraria; Astellas Pharma: Honoraria; Ascentage Pharma Group: Honoraria; Amgen: Honoraria; Abbvie: Consultancy, Honoraria; Precision Biosciences: Honoraria; Shenzhen Target Rx: Honoraria; Taiho Pharmaceutical: Honoraria; Abbvie (Inst): Research Funding; Amgen (Inst): Research Funding; Ascentage Pharma (Inst): Research Funding; Bristol-Myers Squibb (Inst): Research Funding; Novartis (Inst): Research Funding. Garcia-Manero: Genentech: Research Funding; Bristol Myers Squibb: Other: Medical writing support, Research Funding; AbbVie: Research Funding. Montalban-Bravo: Rigel: Research Funding; Takeda: Research Funding.
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