Session: 632. Chronic Myeloid Leukemia: Clinical and Epidemiological: Poster II
Hematology Disease Topics & Pathways:
Research, Combination therapy, Adult, Clinical Research, CML, Chronic Myeloid Malignancies, Diseases, Real-world evidence, Treatment Considerations, Survivorship, Myeloid Malignancies, Study Population, Human
Methods: We retrospectively evaluated the response rates and survival outcomes of pts who received a ponatinib-based regimen at our institution for CML-MBP. Pts could have received ponatinib as any line of therapy for CML-MBP and could have received ponatinib alone or in combination with any chemotherapy backbone. The outcomes of CML-MBP after ponatinib failure were also analyzed.
Results: 76 pts received a ponatinib-based regimen for CML-MBP between 1/2008 and 8/2023. The median age was 50 years (range, 20-90 years). 50 pts (66%) received ponatinib as their first therapy for CML-MBP (4 for de novo CML-MBP and 46 for CML-MBP transformed from previously treated earlier-phase CML); the other 26 pts (34%) received ponatinib as salvage for CML-MBP. 47% of tested pts had at least 1 ABL1 kinase domain (KD) mutation, including 8 pts with T315I, 7 with E255K and 3 with F317L mutations. Ponatinib was given with intensive chemotherapy (IC) in 28 pts (37%), with IC + venetoclax in 7 pts (9%), with hypomethylating agents (HMA) + venetoclax in 18 pts (23%), with HMA (without venetoclax) in 6 pts (8%), and as monotherapy in 17 pts (22%).
The overall response rate (ORR: including CR/CRi/MLFS/PR) with ponatinib-based therapy was 50%, including CR in 26% and CRi in 13% (CR/CRi rate: 40%). The ORR was 62% for pts receiving ponatinib as first therapy for CML-MBP vs. 27% for pts who received ponatinib for relapsed/refractory CML-MBP (P=0.003). The ORR was 56% for ponatinib combination therapy vs. 29% for ponatinib monotherapy (P=0.06). Overall, 28% of pts achieved CCyR and 20% achieved MMR or better.
Among responders, 15 pts were bridged to allogeneic stem cell transplant (ASCT) (20% overall; 40% of responders). 10 pts (67%) received a post-ASCT TKI (ponatinib in 8 and dasatinib and bosutinib in 1 each) for a median duration of 20.1 months. Overall, 8 pts died in remission (3 after ASCT and 5 in the absence of ASCT), none of which were due to ponatinib-related toxicity.
With a median follow-up of 46.3 months, the median RFS was 10.3 months (2-year RFS 32%), and the median OS was 8.5 months (2-year OS 27%). Pts who received ponatinib as first therapy for CML-MBP had better outcomes than those who received it as salvage therapy (2-year OS: 38% vs. 14%, respectively; P=0.005). Among pts who achieved CR/CRi, the median OS was 29.4 months (2-year OS 55%). In a landmark analysis, responding pts who proceeded directly to ASCT had superior outcomes to those who did not (2-year OS 71% vs. 38%, respectively; P=0.06).
49 pts experienced ponatinib failure (30 pts who were refractory to ponatinib and 19 pts who relapsed). Among the 19 relapsed pts, the median duration of response was 4.2 months (range, 1-19 months). Relapse was bone marrow (BM)-only in 13 pts (68%), extramedullary (EM)-only in 4 pts (21%), and BM + EM in 2 pts (11%). Overall, 4/19 relapses (21%) involved the CNS. Among 40 pts who received salvage therapy after ponatinib failure, the ORR to first salvage was 27% and the CR/CRi rate was 20%. 5 pts were bridged directly to ASCT (10% overall; 46% of responders). Following ponatinib failure, outcomes were poor, with a median OS of 3.9 months and 1-year OS rate of 21%.
Conclusion: Ponatinib-based therapies result in high rates of response in CML-MBP, particularly when given as first therapy for CML-MBP and when used in combination with chemotherapy. Pts who are bridged to ASCT have the best outcomes (2-year OS 71%). However, outcomes are dismal after failure of ponatinib, highlighting the need for more effective treatment strategies of CML-MBP.
Disclosures: Jabbour: AbbVie, Adaptive Biotechnologies, Amgen, Astellas Pharma, BMS, Genentech, Incyte, Pfizer, Takeda: Consultancy; AbbVie, Adaptive Biotechnologies, Amgen, Ascentage Pharma Group, Pfizer, Takeda: Research Funding. Issa: Syndax Pharmaceuticals, Inc.: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: consultancy/ad board fees, Research Funding; Astex: Research Funding; Celgene: Research Funding; Merck: Research Funding; NuProbe: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: consultancy/ad board fees, Research Funding; Sanofi: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: consultancy/ad board fees; AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: consultancy/ad board fees; Kura Oncology: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: consultancy/ad board fees, Research Funding; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: consultancy/ad board fees, Research Funding; AstraZeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: consultancy/ad board fees. Sasaki: Enliven: Research Funding; Novartis: Consultancy, Research Funding; Otsuka: Other: Lecture fees; Pfizer: Consultancy; Chugai: Other: Lecture fees; Daiichi-Sankyo: Consultancy. Abbas: Molecular Partners: Consultancy; GlaxoSmithKline: Research Funding; Genentech: Research Funding; Alamar Biosciences: Honoraria; Illumina: Honoraria, Other: Inkind Support, Research Funding; Ascentage: Research Funding; Blueprint Medicines Corporation: Research Funding; Enzyme By Design: Research Funding. Ravandi: Abbvie: Consultancy, Honoraria; Syndax: Honoraria; Xencor: Research Funding; Astellas: Consultancy, Honoraria; BMS: Consultancy, Honoraria; Prelude: Consultancy, Honoraria, Research Funding; Amgen: Research Funding; Syros: Consultancy, Honoraria, Research Funding; Astyex/Taiho: Research Funding. Kantarjian: AbbVie, Amgen, Ascentage, Ipsen Biopharmaceuticals, KAHR Medical, Novartis, Pfizer, Shenzhen Target Rx, Stemline,Takeda: Consultancy, Honoraria. Short: Amgen: Honoraria; Xencor: Research Funding; BeiGene: Honoraria; Autolus: Honoraria; Stemline Therapeutics: Research Funding; Adaptive Biotechnologies: Honoraria; Novartis: Honoraria; Sanofi: Honoraria; Takeda Oncology: Honoraria, Research Funding; Astellas Pharma, Inc.: Honoraria, Research Funding; GSK: Consultancy, Research Funding; NextCure: Research Funding; Pfizer Inc.: Honoraria.
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