Risk Adapted Therapeutic Strategy of Acute Myeloid Leukemia

In this "real-life" retrospective study, we assessed outcome after a "personalized" treatment strategy for patients with acute myeloid leukemia (AML) in a tertiary care center. Our strategy consisted of induction therapy adjusted to age, comorbidities and molecular abnormalities, as well as allogeneic stem cell transplantation (allo-SCT) in first complete remission (CR1), whenever possible, for patients with European Leukemia Net 2017 (ELN) intermediate or high-risk patients. Allo-SCT was followed by post-transplant maintenance consisting of 5-azacytidine (AZA) for most patients, or sorafenib for patients with FLT-3 ITD. We included 99 consecutive patients (65% male). The median age at diagnosis was 49 years (range, 18-88) with 28 patients older than 60. Karyotype was normal in 59 patients. Molecular analysis revealed core binding factor (CBF) mutation in 13 patients (13%), NPM1 mutation in 26 patients (26%), FLT3-ITD and FLT3-TKD mutation in 15 (15%) and 1 (1%) patient, respectively. According to the ELN 2017 classification, 24, 48 and 27 patients belonged to the low, intermediate and high-risk groups, respectively. Patients aged 60. Of those 26 transplanted patients, 24 received post-allo-SCT maintenance consisting of AZA in 18 patients (69%) or sorafenib in 6 patients (23%). Allo-SCT was performed in 20 additional patients at time of relapsed and/or refractory disease, with 14 of them receiving post-transplant maintenance. The median follow-up for alive patients was 35 months. For the whole cohort, the 3-year overall survival (OS) was 54%. In patients aged These results indicate an improved outcome for AML patients who receive a treatment strategy tailored to age, comorbidities, and disease risk with an overall 76% CR rate and a relatively low rate of mortality during induction (7%). The use of allo-SCT in CR1 followed by post-transplant maintenance significantly improved outcome of young patients ( Disclosures No relevant conflicts of interest to declare.