ASH 2021 | Comparing treatment options for treated secondary AML

Sangeetha Venugopal, MD, University of Texas MD Anderson Cancer Center, Houston, TX, shares the findings of a retrospective analysis of outcomes of patients with treated secondary AML with prior hypomethylating agent (HMA) exposure. Treated secondary AML, arising for a previously treated antecedent hematologic disorder, is associated with notoriously poor outcomes and there is no standard frontline treatment. To investigate the optimal therapy in this setting, over 500 patients with prior HMA exposure were studied. Treatment regimens were classified as low-intensity chemotherapy, intensive chemotherapy, or HMA plus venetoclax. Response rates and overall survival were comparable between the low-intensity and intensive chemotherapy groups, but HMA plus venetoclax was associated with improved overall response (OR) and complete response (CR/CRi) rates, and overall survival. Further analysis revealed that the impact of therapies on outcomes was influenced by karyotype, with those with an adverse risk karyotype showing poor outcomes regardless of treatment approach. These results suggest HMA plus venetoclax should be preferentially considered in this patient subgroup, whilst also highlighting the dire need for novel effective therapies for these patients. This interview took place at the 63rd ASH Annual Meeting and Exposition congress in Atlanta, GA.