ASH 2024 | Comparing real-world outcomes with CPX-351 versus fludarabine-based induction in secondary AML
Fabio Guolo, MD, University of Genoa, Genoa, Italy, comments on the benefits of CPX-351 over fludarabine-based induction in secondary acute myeloid leukemia (AML), highlighting that the increased clearance of measurable residual disease (MRD) is likely a key factor in the observed improved outcomes observed in the real-world setting. Dr Guolo notes that CPX-351 allows more patients to proceed to allogeneic stem cell transplantation (alloSCT), resulting in better survival rates. This interview took place at the 66th ASH Annual Meeting and Exposition, held in San Diego, CA.
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Transcript (AI-generated)
This work starts from the observation in the British trial where CPX was compared to fludarabine, idarubicin and cytarabine for high-risk AML, not only secondary AML but all high-risk AML including some secondary AML patients. In the secondary AML subset there was a strong benefit for CPX351 over fludarabine-based approach. But there was not enough data to understand why there was such a benefit...
This work starts from the observation in the British trial where CPX was compared to fludarabine, idarubicin and cytarabine for high-risk AML, not only secondary AML but all high-risk AML including some secondary AML patients. In the secondary AML subset there was a strong benefit for CPX351 over fludarabine-based approach. But there was not enough data to understand why there was such a benefit. We compared in our institution patients who received CPX or fludarabine-based regimen for secondary AML and we observed that most of the benefit comes from an increased MRD clearance probability in patients who received CPX. So CPX leads to more profound response with higher probability of MRD negativity. This alongside with reduced toxicity allows more patients to proceed to allogenic stem cell transplantation in MRD negative complete remission status and in a good clinical shape. And this leads to the observed better survival with CPX.
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