Reassessing adverse prognosis of acute myeloid leukemia harboring BCR::ABL1 in the era of tyrosine kinase inhibitors: A real-world analysis from the PETHEMA registry.

Abstract

Acute myeloid leukemia (AML) harboring BCR::ABL1 is considered a separate diagnostic entity and is classified as adverse in the risk score of the European LeukemiaNet. However, its prognosis could change with the addition of tyrosine kinase inhibitors (TKI) to chemotherapy. In this study, the authors interrogated Programa Español de Tratamientos en Hematología (PETHEMA) AML epidemiologic registry to shed light on the outcome of patients with AML harboring BCR::ABL1. Fifty-seven patients with newly diagnosed AML harboring BCR::ABL1 were included, 40 of them treated intensively. Fifteen patients received TKI and 19 did not receive TKI, median overall survival (mOS) was 15.7 months (95% CI, 3.9-27.6 months) and 12.3 months (95% CI, 0.4-24.1 months), respectively (p = .28). Median relapse-free survival was not reached versus 7.6 months (95% CI, 3-12.2 months) in patients who did or did not receive TKI (p = .029). Age, TKI treatment, allogeneic bone marrow transplantation and date of diagnosis were included in the Cox regression analysis, and no independent prognostic factors for OS were found. Comparison of BCR::ABL1 AML patients with the intensively treated global PETHEMA AML cohort (N = 2107) showed that patients who received a TKI had a median overall survival similar to that of the intermediate‑risk group. This study shows improved outcomes with the addition of TKI to chemotherapy and supports re-classification of AML patients harboring BCR::ABL1 in the intermediate-risk group. Nonetheless, given the small sample size, larger studies are needed to confirm these findings.