ASH 2024 | A multicenter analysis of the management and outcomes of patients diagnosed with CML in blast phase

So for the second abstract, the number 2426, the management of outcomes of patients diagnosed with CML in blast phase, a multicenter analysis by the CML consortium. So the background is, despite multiple TKIs and the newer treatment for AML or ALL, outcomes of patients with CML blast phase or BP remains poor. The consensus guidelines on the management of CML-BP are lacking. A recent study from the ELN reported outcomes of 240 CML-BP patients and they reported marked heterogeneity in treatment patterns and no accepted standards. So our primary objective is to study the treatment patterns and outcomes of patients with CML-BP in the United States. So this is a multi-center retrospective study through the CML consortium. The key findings were that we analyzed the 72 patients with the CML BP, with 50% initially diagnosed with CML CP or chronic phase, and 15% had accelerated phase or AP, and 35% of these patients were diagnosed with the normal CML BP. The median time from CML CP or AP progressed to BP was 26 months. Blasts were predominantly myeloid phenotype. About 50% of the patients had myeloid phenotype, and 40% of patients had a lymphoid phenotype, and 3% of the patients had mixed phenotype. Of the patients with ABL kinase domain mutation tested, 43% had ABL kinase mutation, and most commonly the T315I mutations. The NGS showed that the most common mutations were ASXL1, RUNX1, BCR, followed by others. And the treatment was heterogeneous. 80% of the patients received TKI plus chemotherapy, 13% received TKI alone, and 7% received chemo alone. Response rate was significantly better with the second and third generation of TKI, about 77% to 80%, compared to first generation TKI. The median overall survival was 18 months, with significantly improved outcomes for those receiving TKI combined with chemotherapy, which was 28 months, compared to TKI alone, 13 months, and chemotherapy alone, 4.5 months. For those undergoing allogeneic stem cell transplant, the overall survival was not reached. Compared to patients who didn’t receive allogeneic stem cell transplant, the overall survival was 14 months only. So we conclude that CML blast phase continues to have a dismal prognosis. Treatment is heterogeneous, involving various combinations of TKI and chemotherapy. In our analysis, treatment with second or third generation TKI led to better responses. In addition, treatment with chemotherapy in combination with TKI and allogeneic stem cell transplant led to improved overall survival. Currently, the data from other institutions is being updated for further analysis and publication. Thank you.

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