(053) CPX-351 Induction for Acute Myeloid Leukemia followed by CPX-351 Versus Other Consolidation Chemotherapy

Poster Abstract: Poor risk acute myeloid leukemia (AML) accounts for about 25% of AML cases; these poor risk AML subtypes include AML arising after previous therapy (t-AML) and patients with myelodysplasia-related changes (AML-MRC). T-AML and AML-MRC are unlikely to be cured with chemotherapy alone; the treatment goal for these patients is to induce remission with chemotherapy and proceed to allogeneic hematopoietic cell transplantation (alloHCT). If unfit for alloHCT, or a suitable allogenic donor is unavailable, then the strategy shifts to maintaining the patient in remission.
CPX-351 is a dual-drug liposomal encapsulation of cytarabine and daunorubicin providing a long half-life and intracellular delivery of drug into leukemic cells. Phase 3 data shows poor risk AML patients who receive CPX-351 with or without an alloHCT have improved survival. The CPX-351 regimen consists of 1-2 cycles of induction followed by up to two cycles of consolidation in patients who attain a complete response (CR) or CR with incomplete recovery (CRi) after induction therapy. If fit enough for transplant, patients should proceed to alloHCT. Many patients who proceed to alloHCT receive chemotherapy consolidation to maintain remission until the alloHCT. Consolidation strategies other than CPX-351 in this setting most commonly includes high-dose cytarabine or a hypomethylating agent like azacitidine or decitabine with or without venetoclax and may be used in patients who do not tolerate CPX-351 induction, have cardiotoxicity risk because of reduced ejection fraction and/or previous anthracycline exposure, or doctor/patient preference. Data on outcomes in patients receiving other regimens post-CPX-351 induction are lacking.
A retrospective, single-center review of electronic medical records will be performed between June 1, 2018 and July 31, 2023. The primary outcome is median progression free survival (PFS) after initiation of post-remission therapy in patients with t-AML or AML-MRC who achieved at least CRi after 1-2 cycles of induction with CPX-351 and received at least one cycle of post-remission chemotherapy. Patients will be excluded if they received other chemotherapy or targeted therapies in combination with CPX-351. Secondary outcomes include: median PFS for patients who met AML-MRC definition, rate of alloHCT, time to alloHCT, mortality rates, time to relapse, minimum residual disease conversion, and median PFS in different AML mutation and risk groups. The following data will be collected: baseline characteristics, AML disease, treatment, and response information, and alloHCT information. This study will provide data on non-CPX-351 post-remission strategies after patients receive a response from CPX-351 and insight on real-life practices at Barnes-Jewish Hospital.

References (must also be included in final poster): 1. Cancer Facts and Figures. American Cancer Society. 2023.
2. Lancet JE, Uy GL, Cortes JE, et al. CPX-351 (cytarabine and daunorubicin) Liposome for Injection Versus Conventional Cytarabine Plus Daunorubicin in Older Patients With Newly Diagnosed Secondary Acute Myeloid Leukemia. J Clin Oncol. 2018 Sep 10;36(26):2684-2692.