17 / 32
with secondary AML, 77% achieved CR or
CRi. The median relapse-free survival is 9.1
months, with 42% overall survival at a median
of 10 months of follow-up.
These results demonstrate the tolerability and
favourable survival data in patients with AML
treated with 33A plus hypomethylating agents.
Acute lymphoblastic leukaemia:
clinical studies
Abstract 758
: Minimal residual disease
assessment of remission after induction therapy
is superior to morphologic assessment for risk
stratification in childhood acute lymphoblastic
leukemia: a report from the Children’s Oncology
Group (COG).
S Gupta, M Devidas, S Chen, et al
This cohort of 9350 patients <31 years
of age with B-ALL (n=7857) and T-ALL
(n=1493) enrolled in COG trials underwent
bone marrow assessment of remission
following induction therapy via morphology
and MRD to evaluate outcomes and for
risk assessment. Because few patients with
M2/M3 marrows had discordant low MRD
values, analyses were restricted to patients
with M1 morphology and MRD
≥
5%.
Discordance was significantly more common
among patients with T-ALL compared with
B-ALL. Patients with B-ALL who had M1
morphology and discordant MRD exhibited
improved 5-year event-free survival (EFS)
compared with patients with M2 morphology
and discordant MRD, but exhibited inferior
EFS compared with patients with M1
morphology and discordant MRD. Patients
with T-ALL had similar 5-year EFS for M1
and M2 morphologies with discordant MRD.
These findings demonstrate that patients with
morphologically defined remission but MRD
≥
5% exhibit outcomes similar to outcomes in
patients who do not achieve morphological
remission, suggesting that MRD should
replace morphology in defining remission in
this patient population.
Chronic myeloid leukaemia: therapy
Abstract 939:
Upfront imatinib with selective
early switching to nilotinib leads to excellent
achievement of deep molecular response in
chronic phase CML: 5 year (final) analysis of
the TIDEL-II study.
DT Yeung, MP Osborn, DL
White, et al
This study enrolled 210 patients with a median
age of 49.7 years and newly diagnosed CML
in chronic phase across 27 Australasian
sites. Patients received imatinib (IM) and
were switched to nilotinib (NIL) based on
IM intolerance or failure to achieve timely
molecular response. Prior to 24 months, 75
patients switched toNIL due to IM intolerance
(n=20) or failing to achieve targets (n=55). The
5-year OS and transformation-free survival
were 95% and 92%, respectively, with 86% of
patients achieving major molecular response
(MMR) and 59% of patients achieving MR
4.5
(BCR-ABL1
≤
0.0032%) by 60 months. Of
these patients, 24% achieved MMR and 23%
achieved MR
4.5
after switching to NIL. The
median IM dose was 500 mg once daily. Only
9/51 patients who dose-escalated to 800 mg
once daily remained on this dose through 60
months.
These findings demonstrate the success of
the combination strategy of IM and NIL
through achievement of MR
4.5
in 59% of
patients by 60 months.
Clinical allogeneic transplantation:
conditioning regimens, engraftment,
and acute transplant toxicities
Abstract 982:
Transplant-associated
thrombotic microangiopathy: prevalence,
prognostic factors and treatment outcomes
in unrelated allogeneic transplant for
haematologic diseases.
I Sakellari, I Batsis,
Z Boussiouu, et al
This retrospective study included 179
patients (74 men, 105 women, aged 37±14
years) who underwent HCT from matched
HLA A/B/C/DRB1 (n=88) and allele- or
antigen-mismatched (n=91) grafts and
evaluated transplant-associated thrombotic
microangiopathy (TA-TMA) to investigate
prognostic factors and treatment outcomes.
TA-TMA was diagnosed in 29 patients, which
was significantly associated with severe acute
GVHD on multivariate analysis. Of these
patients with TA-TMA, 8 responded to
cyclosporine cessation and plasma infusions,
14 responded to plasma exchange treatment,
1 patient who did not respond to plasma
exchange responded to additional rituximab
therapy, and the remaining 6 patients
eventually succumbed to treatment-related
refractory microangiopathic syndrome.
This study suggests that TA-TMA is associated
with GVHD, highlighting the importance of
timely prevention and treatment strategies
to prevent complications. Furthermore,
TA-TMA is manageable in patients who
respond to cyclosporine cessation and
plasma exchange, but conventional treatment
is inadequate in patients with refractory
microangiopathic syndrome.
© ASH 2016
ASH 2016
17
VOL. 2 • NO. 1 • 2017