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2893 Venetoclax and Azacitidine for Relapse Prevention in NPM1-Mutated Acute Myeloid Leukemia in Molecular Failure: Results from the Ongoing Gimema AML2521 Phase 2 Trial

Program: Oral and Poster Abstracts
Session: 617. Acute Myeloid Leukemias: Commercially Available Therapies: Poster II
Hematology Disease Topics & Pathways:
Acute Myeloid Malignancies, AML, Research, Clinical trials, Clinical Research, Diseases, Myeloid Malignancies, Measurable Residual Disease
Sunday, December 8, 2024, 6:00 PM-8:00 PM

Chiara Sartor, MD1,2*, Anna Candoni3*, Alfonso Piciocchi4*, Giovanni Marsili4*, Paola Fazi4*, Cristina Papayannidis, MD, PhD5, Stefania Paolini, MD, PhD6*, Gianluca Cristiano, MD7*, Luca Maurillo, MD8*, Mario Tiribelli, MD9*, Antonino Mulè, MD10*, Melissa Campanelli11*, Giovanni Marconi, MD12,13, Paola Minetto, MD14, Emanuela Ottaviani, MSc5*, Maria Teresa Voso, MD15, Francesca Bonifazi16*, Attilio Olivieri17*, Pellegrino Musto18*, Francesco Di Raimondo, MD, Prof19, Roberto Massimo Lemoli, MD20*, Maria Paola Martelli, MD, PhD21*, Brunangelo Falini22, Michele Cavo, MD5,23*, Adriano Venditti8, Francesco Buccisano, MD15 and Antonio Curti, MD, PhD6

1Istituto di Ematologia “Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
2Department of Medical and Surgical Sciences - University of Bologna, Bologna, Italy
3Hematology Unit, Section of Haematology, Dept. of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Modena, Italy
4GIMEMA Foundation, Rome, Italy
5IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
6IRCCS Azienda Ospedaliero-Universitaria di Bologna – Institute of Hematology “Seràgnoli", Bologna, Italy
7Department of Medical and Surgical Sciences, Institute of Hematology "L. and A. Seràgnoli", University of Bologna, Bologna, Italy
8Department of Onco-Hematology, Fondazione Policlinico Tor Vergata, Rome, Italy
9Division of Hematology and BMT, Department of Medical Area, University of Udine, Udine, Italy
10UOC di Oncoematologia,, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
11POLICLINICO UMBERTO I HOSPITAL, ROME, ITA
12Hematology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, Meldola, Italy
13University of Bologna, Dipartimento di Scienze Mediche e Chirurgiche, Bologna, Italy
14IRCCS Ospedale Policlinico San Martino, Genoa, Italy
15Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
16IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
17Hematology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Ancona, Italy
18Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, Bari, Italy
19Hematology and Bone Marrow Transplatation Unit, Azienda Ospedaliero Universitaria Policlinico G. Rodolico-San Marco, Catania, Italy
20Clinic of Hematology, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Genoa, Italy
21Department of Medicine and Surgery, Division of Hematology and Clinical Immunology, University of Perugia, Perugia, Italy
22Institute of Hematology and Center for Hemato-Oncology Research, University and Hospital of Perugia, Perugia, Italy
23Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, Bologna, Italy

Background: Molecular failure (MF) after first line intensive chemotherapy (IC) in NPM1-mutated (NPM1m) AML identifies higher risk patients who will inevitably relapse if untreated and who require treatment intensification with allogeneic stem cell transplantation (alloSCT). However, no therapy is currently available in the measurable residual disease (MRD) setting, although increasing evidence supports both the value of an early intervention and the efficacy of venetoclax (VEN) and azacitidine (AZA) in NPM1m AML.

Aim: To evaluate the efficacy of VEN-AZA in preventing morphological relapse as a bridge-to-transplant strategy in adult NPM1m AML patients who experience MF during IC treatment or subsequent follow-up monitoring.

Methods: This is the GIMEMA AML2521 trial (ClinicalTrials.gov NCT04867928); a phase 2, non-randomized, interventional, open-label, multicenter trial enrolling fit-for-transplantation adult NPM1m AML patients in molecular relapse or progression after having received at least 2 cycles of IC. Inclusion criteria comprise: 1) morphological complete remission (CR); 2) centralized MRD positivity defined as NPM1m transcript/ABL1 x 100 ≥ 0.01%, evaluated with qRT-PCR. Patients receive VEN 400 mg (50 mg if concomitant posaconazole) on days 1-28 in association with azacitidine 75 mg/m2 days on 1-7. AlloSCT is recommended at any time at MRD-negativity (MRDneg), defined as NPM1m < 0.01%, from cycle (C)1 onwards.

Results: Twenty-four NPM1m AML patients have been screened, of which 20 resulted eligible for the study. Five patients are currently undergoing C1, thus we present data of the first 15 patients enrolled. Median patient age is 55 years (range 48-62), 7 of 15 (47%) are male, all patients have ECOG=0. AML characteristics at diagnosis show concomitant FLT3-ITD mutation in 5 (33%) of patients and FLT3-TKD in 3 (20%); 1 patient presented ELN2022 adverse risk for TP53 mutation. At enrolment, all patients were in confirmed CR, median NPM1m values were 0.188 (IQR 0.087, 1.615), no patients presented detectable FLT3 mutations. Patients received a median of 3 cycles (range 1-6) of VEN-AZA. Concerning primary endpoint, no patients experienced morphological relapse while on study treatment. Overall, 9 (60%) patients achieved MRDneg during treatment and 3 (20%) a molecular response (NPM1m decrease ≥1 log), for an overall molecular response (OMR) of 80%. Median time to MRDneg is 1.64 months (IQR1.31, 3.02). So far 13 (87%) of patients have been bridged to alloSCT in CR or better. Median time to transplant is 3.45 mo (IQR 3.09, 4.24). Concerning safety, the most frequent adverse events (AEs) ≥ G3 related to study drug, as expected, were of hematological nature, involving 7 of 15 (47%) patients. Overall, 15 AEs ≥ G3 were reported: 10 neutropenia, 3 thrombocytopenia, 1 pancytopenia; only 1 (7%) patient experienced febrile neutropenia G3. With a median follow-up of 9.8 mo (IQR 6.4, 17.0), all patients are alive and in CR.

Conclusions: This preliminary data shows promising results for AZA-VEN in preventing disease relapse and in bridging safely and effectively NPM1m AML patients in MF to alloSCT. Updated data will be presented at meeting in case of abstract selection. This study has been conducted with the support of Abbvie SRL.

Disclosures: Sartor: Novartis: Honoraria; Abbvie: Honoraria; Amgen: Honoraria. Candoni: Incyte: Honoraria; Abbvie: Honoraria; Janssen: Honoraria; BMS: Honoraria; Pfizer: Honoraria; Astellas: Honoraria. Papayannidis: Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Astellas: Honoraria, Membership on an entity's Board of Directors or advisory committees; Servier: Honoraria; Menarini/Stemline: Honoraria; BMS: Honoraria; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Incyte: Honoraria; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; GSK: Membership on an entity's Board of Directors or advisory committees; Blueprint: Membership on an entity's Board of Directors or advisory committees; Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Delbert Laboratories: Membership on an entity's Board of Directors or advisory committees. Voso: Abbvie: Speakers Bureau; Novartis: Other: Research support, Speakers Bureau; Celgene/BMS: Other: Research support, Advisory Board, Speakers Bureau; Astra Zeneca: Speakers Bureau; Syros: Other: Advisory Board; Jazz: Other: Advisory Board, Speakers Bureau; Astellas: Speakers Bureau. Bonifazi: NEOVII: Honoraria; JAZZ PHARMACEUTICALS: Honoraria, Speakers Bureau; AMGEN: Honoraria, Speakers Bureau; TAKEDA: Honoraria, Speakers Bureau; SANOFI: Honoraria; KITE: Honoraria, Speakers Bureau; PFIZER: Honoraria, Speakers Bureau; bms: Honoraria, Speakers Bureau; JANSSEN: Honoraria, Speakers Bureau; MSD: Honoraria, Speakers Bureau. Musto: Amgen: Honoraria; Abbvie: Honoraria; Bristol-Myers Squibb: Honoraria; Astellas: Honoraria; Gilead: Honoraria; Sanofi: Honoraria; Astra-Zeneca: Honoraria; Novartis: Honoraria; Pfizer: Honoraria; Incyte: Honoraria; Johnson & Johnson: Honoraria; Jazz: Honoraria; Roche: Honoraria; Sobi: Honoraria; Bei-Gene: Honoraria; Takeda: Honoraria; Glaxo-Smith-Kline: Honoraria; Grifols: Honoraria; Alexion: Honoraria. Lemoli: Jazz Pharma: Speakers Bureau. Venditti: BMs celgene: Consultancy, Other: invited speaker; AstraZeneca: Consultancy; pfizer: Consultancy, Other: invited speaker; jazz: Consultancy, Other: invited speaker, Research Funding; astellas: Consultancy, Other: invited speaker; servier: Consultancy, Other: invited speaker; beigene: Consultancy; Abbvie: Consultancy, Other: invited speaker; Gilead: Consultancy, Other: invited speaker; menarini: Consultancy, Other: invited speaker; Janssen: Consultancy, Other: invited speaker; glycostem: Consultancy; laboratories Delbert: Consultancy; istituto gentili: Consultancy. Buccisano: Servier: Honoraria, Speakers Bureau; Delbert Pharma: Honoraria; Jazz Pharmaceuticals: Honoraria, Speakers Bureau; Novartis: Honoraria. Curti: Abbvie: Honoraria; Menarini stemline: Honoraria; Jazz Pharmaceutics: Honoraria; Pfizer: Honoraria, Research Funding.

*signifies non-member of ASH