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4942 Frequency and Impact of Somatic Mutations Alone or in Combination on Post-Transplant Outcomes in Acute Myeloid Leukemia: A Large Study on Behalf of the EBMT Acute Leukemia Working Party

Program: Oral and Poster Abstracts
Session: 732. Allogeneic Transplantation: Disease Response and Comparative Treatment Studies: Poster III
Hematology Disease Topics & Pathways:
Research, Acute Myeloid Malignancies, AML, Adult, Translational Research, Epidemiology, Clinical Research, Diseases, Real-world evidence, Registries, Myeloid Malignancies, Study Population, Human
Monday, December 9, 2024, 6:00 PM-8:00 PM

Ali Bazarbachi, MD, PhD1, Jacques-Emmanuel Galimard, PhD2*, Myriam Labopin3*, Iman Abou Dalle, MD4*, Matthew Collin, MD, PhD5, Celestine Simand, MD6*, Jaime Sanz7*, Maria Jesús Pascual, MD8*, Jiri Mayer, MD9, Khalid Halahleh, MD10*, Xavier Poiré, MD, PhD11*, Patrizia Chiusolo, MD, PhD12*, Johan Maertens13*, Maija Itala-Remes14*, Ann De Becker15*, Laimonas Griskevicius16*, Pavel Jindra17*, Soledad GONZALEZ Muñiz18*, Ain Kaare, MD19*, Maria Pilar Gallego Hernanz, MD20*, He Huang21*, Carlos Solano, MD, PhD22, Gesine Bug, MD23*, Josep-Maria Ribera, MD, PhD24, Alain Gadisseur, MD, PhD25*, Christoph Schmid, MD26*, Mi Kwon, MD, PhD27, Paola Coccia28*, Manuel Jurado Chacón29*, Frederic Baron30, Charles Craddock, FRCP, FRCPath31, Eolia Brissot32, Arnon Nagler, MD33, Fabio Ciceri, MD34* and Mohamad Mohty, MD, PhD35

1American University of Beirut Dept. of Medicine, Beirut, Lebanon
2EBMT Paris Study Unit, Saint Antoine Hospital, INSERM UMR-S 938, Sorbonne University, Paris, France
3Hematology Department, Hôpital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, Paris, France, Paris, France
4Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut medical center, Beirut, Lebanon
5Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
6Hematology, Institut de Cancerologie Strasbourg Europe (ICANS), Strasbourg, France
7Hematology Department, Hospital Universitari i Politècnic La Fe, Departament de Medicina Universitat de Valencia, CIBERONC, Instituto Carlos III, Spain, VALENCIA, Spain
8Hospital Regional de Málaga, Málaga, Spain
9Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
10king Hussein cancer center internal medicine department, Amman, Jordan
11Cliniques Universitaires St. Luc, Brussels, Belgium
12UOC Ematologia e Trapianto Cellule Staminali Emopoietiche, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Rome, Italy
13University Hospital Gasthuisberg, Leuven, Belgium
14Turku University Hospital, Turku, Finland
15Universitair Ziekenhuis Brussel, Brussels, Belgium
16Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania, Vilnius, Lithuania
17Charles University Hospital, Pilsen, Czech Republic
18Hospital Universitario Central de Asturias, Oviedo, Spain, OVIEDO, ESP
19Tartu Univerity Clinics, Tartu, Estonia
20Hematology Department, CHU de Poitiers, Poitiers, France
21First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
22University of Valencia, Valencia, Spain
23Department of Medicine 2, Goethe University Frankfurt, Frankfurt, Germany
24Hospital Universitari Germans Trias i Pujol/Catalan Institute of Oncology, Badalona, Barcelona, Spain
25Antwerp University Hospital, Edegem, Belgium
26Department of Hematology, University Hospital Augsburg, Augsburg, Germany
27General University Hospital Gregorio Marañón, Madrid, Spain
28Azienda Ospedali Riuniti di Ancona, Ancona, Ancona, Italy
29Hospital Univ. Virgen de las Nieves, Granada, Spain
30University of Liege, Liege, Belgium
31Queen Elizabeth Hospital, Birmingham, United Kingdom
32Sorbonne Universités, UPMC Univ Paris 06, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France, Paris, France
33Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Aviv, Israel
34Hematology and Bone Marrow Transplantation Unit, I.R.C.C.S. San Raffaele Scientific Institute, Milan, Italy
35Sorbonne University, Hôpital Saint-Antoine, and INSERM UMRs938, Paris, France

Background: Acute myeloid leukemia (AML) is a very heterogeneous malignancy, which includes numerous genetically defined subsets. In the context of allogeneic hematopoietic stem cell transplantation (allo-HSCT), the frequency and prognostic value of different gene-gene interactions has not been studied and may differ from that of patients treated with chemotherapy alone. We aimed at evaluating, through the European Society for Blood and Marrow Transplantation (EBMT) database, the frequency and impact of different recurrent somatic mutations, either alone or in association, on relapse and survival in patients receiving allo-HSCT.

Methods: This is a retrospective, registry-based analysis with the approval of the EBMT Acute Leukemia Working Party. Adult patients with a diagnosis of AML who received an allo-HSCT between 2013-2023, with an available genetic profile determined at diagnosis by next generation sequencing (NGS) were included.

Results: We identified 1403 allografted AML patients who had NGS performed at diagnosis. The most frequent detectable mutations by frequency were DNMT3A (20%), FLT3-ITD (19%), NPM1 (18%), TET2 (14%), RUNX1 (13%), NRAS (11%), IDH2 (10%), ASXL1 (9%), SRSF2 (7%), IDH1 (7%), FLT3-TKD (7%), BCOR (7%), NF1 (7%), WT1 (7%), PTPN11 (6%), KRAS (6%), CEBPA (5%), TP53 (5%) and STAG2 (5%). By multiple correspondence analysis, three independent groups of co-occurring mutations were identified, the first group included DNMT3A, NPM1 and FLT3-ITD, the second group included ASXL1, SRSF2 and RUNX1, the third group included TP53 mutation. Outcome analysis was performed on the subset of 848 patients allografted in CR1 with available data for the aforementioned seven genes (DNMT3A, NPM1, FLT3, ASXL1, SRSF2, RUNX1 and TP53). Most of these patients had de novo AML (74%), with a median age of 55 years (range: 18-75 years). Patients received primarily reduced intensity conditioning (58%) and peripheral blood stem cells (92%) from matched sibling donors (33%), matched unrelated (29%), and haploidentical donors (17%). By ELN 2022, 4% of these patients had favorable-risk cytogenetics, 68% intermediate-risk, and 29% adverse-risk. When outcome analysis was performed according to the presence or absence of single mutations, TP53 mutation significantly increased the 2-year relapse incidence (RI) and decreased leukemia-free survival (LFS) and overall survival (OS) whereas IDH2 mutation significantly decreased the 2-year RI and improved LFS and OS. RI increased with SF3B1 and KMT2A mutation and decreased in the presence of CEBPA or KIT mutation. OS was positively affected by NPM1 mutation and negatively affected by NRAS mutation. According to the 3 groups identified in theMCA analysis and the known impact of NMP1 in the literature, five groups were built: Group 1 comprising TP53 mutation regardless of other co-mutations (N=46; 5%); Group 2 comprising NPM1 mutation and wild type TP53 regardless of other co-mutations (N=140; 17%); Group 3 comprising FLT3-ITD and/or DNMT3A mutation, wild type NPM1 and TP53, regardless of other co-mutations (N= 154; 18%); Group 4 comprising RUNX1 and/or ASXL1 and/or SRSF2 mutation without FLT3-ITD and with wild type NPM1, DNMT3A and TP53 (N=131; 15%); Group 5 with all seven genes unmutated (N=377; 44%). Groups differed for median age (60, 54, 57, 58 and 52 respectively), secondary AML (52%, 15%, 18%, 34% and 26% respectively) and adverse cytogenetics (73%, 8%, 20%, 30%, and 35% respectively). Groups of somatic mutations significantly affected the 2-year RI (45%, 19%, 25%, 15% and 25% for the 5 groups respectively; p<0.01), LFS (29%, 68%, 59%, 76% and 58% respectively; p<0.0001) and OS (41%, 75%, 68%, 84% and 65% respectively; p<0.0001) whereas non relapse mortality was not significantly affected.

Conclusion: NGS at diagnosis can be extremely useful in risk stratification of AML patients undergoing allo-HSCT, potentially allowing adequate post-transplant interventions. Surprisingly, despite their older age and higher frequency of secondary AML and adverse cytogenetics, the best outcomes (2 year LFS 76%, OS 84%) were observed for patients harboring RUNX1 and/or ASXL1 and/or SRSF2 in the absence of FLT3-ITD or NPM1, DNMT3A and TP53 mutation, indicating that allo-HSCT can overcome the adverse risk associated with these somatic mutations at diagnosis.

Disclosures: Bazarbachi: Caribou: Honoraria; Roche: Honoraria, Research Funding; Biologix: Research Funding; Jansen: Honoraria, Research Funding; Pfizer: Research Funding; Takeda: Honoraria; Amgen: Honoraria. Mayer: Novartis: Research Funding; AstraZeneca: Research Funding; AOP Health: Research Funding; Merck & Co., Inc., Rahway, NJ, USA: Research Funding. Jindra: BMS: Honoraria; AbbVie: Honoraria; Janssen: Honoraria; Novartis: Honoraria, Other: Travel support; Takeda: Honoraria; AstraZeneca: Other: Travel support; MSD: Other: Travel support; Roche: Other: Travel support. Ribera: Incyte: Honoraria; Novartis: Honoraria; Takeda: Honoraria; AMGEN: Honoraria; Pfizer: Honoraria. Kwon: Gilead-Kite: Honoraria, Research Funding, Speakers Bureau; Jazz: Speakers Bureau; Sanofi: Honoraria; Pfizer: Speakers Bureau. Ciceri: ExCellThera: Membership on an entity's Board of Directors or advisory committees. Mohty: Janssen: Consultancy, Honoraria, Research Funding, Speakers Bureau; Amgen: Honoraria; Pfizer: Consultancy, Current holder of stock options in a privately-held company, Honoraria, Research Funding, Speakers Bureau; Jazz: Consultancy, Honoraria, Research Funding, Speakers Bureau; Stemline Menarini: Honoraria; Novartis: Honoraria; GSK: Honoraria; Takeda: Honoraria; BMS: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria, Research Funding, Speakers Bureau; Adaptive: Honoraria; MaaT Pharma: Current equity holder in publicly-traded company.

*signifies non-member of ASH