Hypomethylating agent monotherapy in core binding factor acute myeloid leukemia: a French multicentric retrospective study

TL;DR

This study evaluates the effectiveness and safety of hypomethylating agents in treating a specific type of leukemia called CBF-AML.

Contribution

The study provides new insights into the use of hypomethylating agents as a treatment option for CBF-AML patients.

Findings

HMA monotherapy showed an overall response rate of 49% in CBF-AML patients.

Responders had significantly better survival rates compared to non-responders.

Hematological improvement was observed in a subset of patients with transfusion dependence or neutropenia.

Abstract

Very few data are available about hypomethylating agent (HMA) efficiency in core binding factor acute myeloid leukemias (CBF-AML). Our main objective was to evaluate the efficacy and safety of HMA in the specific subset of CBF-AML. Here, we report the results of a multicenter retrospective French study about efficacy of HMA monotherapy, used frontline or for R/R CBF-AML. Forty-nine patients were included, and received a median of 5 courses of azacitidine (n = 46) or decitabine (n = 3). ORR was 49% for the whole cohort with a median time to response of 112 days. After a median follow-up of 72.3 months, median OS for the total cohort was 10.6 months. In multivariate analysis, hematological relapse of CBF-AML at HMA initiation was significantly associated with a poorer OS (HR: 2.13; 95%CI: 1.04–4.36; p = 0.038). Responders had a significantly improved OS (1-year OS: 75%) compared to non-responders (1-year OS: 15.3%; p < 0.0001). Hematological improvement occurred for respectively 28%, 33% and 48% for patients who were red blood cell or platelet transfusion-dependent, or who experienced grade 3/4 neutropenia at HMA initiation. Adverse events were consistent with the known safety profile of HMA. Our study highlights that HMA is a well-tolerated therapeutic option with moderate clinical activity for R/R CBF-AML and for patients who cannot handle intensive chemotherapy.

The online version contains supplementary material available at 10.1007/s00277-024-05623-0.

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