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Appelbaum JS, Wei AH, Mandrekar SJ, Tiong IS, Chua CC, Teh TC, Fong CY, Ting SB, Weber D, Benner A, Hill H, Saadati M, Yin J, Stone RM, Garcia-Manero G, Erba HP, Uy GL, Marcucci G, Larson RA, Thomas A, Freeman SD, Almuina NM, Döhner K, Thomas I, Russel NH, Döhner H, Othus M, Estey EH, Walter RB. Clinical evaluation of complete remission (CR) with partial hematologic recovery (CRh) in acute myeloid leukemia: a report of 7235 patients from seven cohorts. Leukemia 2024; 38:389-392. [PMID: 38263433 PMCID: PMC10996038 DOI: 10.1038/s41375-024-02143-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Affiliation(s)
- Jacob S Appelbaum
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Division of Hematology and Oncology, University of Washington, Seattle, WA, USA
- Seattle Children's Therapeutics, Seattle Children's Hospital, Seattle, WA, USA
| | - Andrew H Wei
- Department of Clinical Haematology, Peter MacCallum Cancer Centre, and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Division of Blood Cells and Blood Cancer, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Sumithra J Mandrekar
- Department of Quantitative Health Sciences, Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Ing S Tiong
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- The Malignant Haematology, Transplantation and Cellular Therapies Service, Alfred Hospital, Melbourne, VIC, Australia
- Australasia Leukaemia and Lymphoma Group (ALLG), Richmond, VIC, Australia
| | - Chong Chyn Chua
- The Malignant Haematology, Transplantation and Cellular Therapies Service, Alfred Hospital, Melbourne, VIC, Australia
- Australasia Leukaemia and Lymphoma Group (ALLG), Richmond, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Haematology, Northern Hospital, Melbourne, VIC, Australia
| | - Tse-Chieh Teh
- The Malignant Haematology, Transplantation and Cellular Therapies Service, Alfred Hospital, Melbourne, VIC, Australia
- Department of Haematology, Eastern Health, Box Hill, VIC, Australia
| | | | - Stephen B Ting
- Eastern Health, Box Hill Hospital and Monash University, Melbourne, VIC, Australia
| | - Daniela Weber
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Hannah Hill
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Maral Saadati
- Freelance Statistician, Saadati Solutions, Ladenburg, Germany
| | - Jun Yin
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Richard M Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Geoffrey L Uy
- Washington University School of Medicine, St. Louis, MO, USA
| | - Guido Marcucci
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Abin Thomas
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Sylvie D Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Konstanze Döhner
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Ian Thomas
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Nigel H Russel
- School of Medicine, Nottingham University, Nottingham, UK
| | - Hartmut Döhner
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Megan Othus
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
| | | | - Roland B Walter
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
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Freeman SD, Thomas A, Thomas I, Hills RK, Vyas P, Gilkes A, Metzner M, Jakobsen NA, Kennedy A, Moore R, Almuina NM, Burns S, King S, Andrew G, Gallagher KME, Sellar RS, Cahalin P, Weber D, Dennis M, Mehta P, Knapper S, Russell NH. Fractionated vs single-dose gemtuzumab ozogamicin with determinants of benefit in older patients with AML: the UK NCRI AML18 trial. Blood 2023; 142:1697-1707. [PMID: 37595359 PMCID: PMC10667325 DOI: 10.1182/blood.2023020630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/25/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023] Open
Abstract
Addition of gemtuzumab ozogamicin (GO) to induction chemotherapy improves outcomes in older patients with acute myeloid leukemia (AML), but it is uncertain whether a fractionated schedule provides additional benefit to a single dose. We randomized 852 older adults (median age, 68-years) with AML/high-risk myelodysplasia to GO on day 1 (GO1) or on days 1 and 4 (GO2) of course 1 induction. The median follow-up period was 50.2 months. Although complete remission (CR) rates after course 1 did not significantly differ between arms (GO2, 63%; GO1, 57%; odds ratio [OR], 0.78; P = .08), there were significantly more patients who achieved CR with a measurable residual disease (MRD)<0.1% (50% vs 41%; OR, 0.72; P = .027). This differential MRD reduction with GO2 varied across molecular subtypes, being greatest for IDH mutations. The 5-year overall survival (OS) was 29% for patients in the GO2 arm and 24% for those in the GO1 arm (hazard ratio [HR], 0.89; P = .14). In a sensitivity analysis excluding patients found to have adverse cytogenetics or TP53 mutations, the 5-year OS was 33% for GO2 and 26% for GO1 (HR, 0.83; P = .045). In total, 228 (27%) patients received an allogeneic transplantation in first remission. Posttransplant OS was superior in the GO2 arm (HR, 0.67; P = .033); furthermore, the survival advantage from GO2 in the sensitivity analysis was lost when data of patients were censored at transplantation. In conclusion, GO2 was associated with a greater reduction in MRD and improved survival in older adults with nonadverse risk genetics. This benefit from GO2 was dependent on allogeneic transplantation to translate the better leukemia clearance into improved survival. This trial was registered at www.isrctn.com as #ISRCTN 31682779.
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Affiliation(s)
- Sylvie D. Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Abin Thomas
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Ian Thomas
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Robert K. Hills
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Paresh Vyas
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Amanda Gilkes
- Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Marlen Metzner
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Niels Asger Jakobsen
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Alison Kennedy
- Wellcome, Medical Research Council Cambridge Stem Cell Institute, University of Cambridge, Cambridge, United Kingdom
| | - Rachel Moore
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Sarah Burns
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Sophie King
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Georgia Andrew
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Kathleen M. E. Gallagher
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Rob S. Sellar
- UCL Cancer Institute and University College London Hospital, London, United Kingdom
| | - Paul Cahalin
- Blackpool Teaching Hospitals National Health Service Foundation Trust, Blackpool, United Kingdom
| | | | - Mike Dennis
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Priyanka Mehta
- The University of Bristol and Weston National Health Service Trust, Bristol, United Kingdom
| | - Steven Knapper
- Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Nigel H. Russell
- Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
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