Highlights from

ASH 2020

62nd Annual Meeting & Exposition of the American Society of Hematology

Virtual 5 - 8 December 2020

Cytoreductive chemotherapy in acute myeloid leukaemia deemed safe

Pre-treatment cytoreductive therapy was found to be safe and feasible in patients with newly diagnosed acute myeloid leukaemia (AML). Receiving this therapy allowed for the collection of genomic data and facilitated enrolment in clinical trials that investigated targeted therapies. There was no difference in overall survival, progression-free survival, or early mortality between the group who received cytoreductive therapy and the group who did not [1].

AML is a rapidly deteriorating disease that is often accompanied by leucocytosis and organ infiltration and must be treated urgently with chemotherapy. The wide heterogeneity of AML poses a treatment dilemma; while genetic and molecular profiling should be executed to identify targeted therapy, the delay in therapy while awaiting this information can negatively impact survival. Researchers speculated that cytoreductive strategies could be implemented in the interim, with no negative impact on outcome.

Dr Kim Kunhwa (University of Texas MD Anderson Cancer Center, Texas) discussed the trial that she and her team designed and executed between April 2014 and May 2020. From 276 patients newly diagnosed with AML, 97 (35.1%) received cytoreductive therapy prior to receiving individualised, targeted therapy in a clinical trial. The remaining 179 (64.9%) patients in the group did not undergo pre-treatment cytoreductive therapy. Cytoreductive strategies consisted of hydroxyurea with or without cytarabine. The mean time from presentation to definitive treatment was 6 days in both groups.

There was no difference in the rate of complete remission/complete remission with incomplete haematologic recovery among patients with or without cytoreduction, respectively (89% vs 87%; P=0.72). Similarly, there was no difference in 30- and 60-day mortality between the groups. Median overall survival among patients with or without cytoreduction was 11.3 versus 11.5 months, respectively (P=0.57). There was also no difference in progression-free survival between the 2 groups (P=0.59).

Based on these data, researchers suggest that urgent cytoreduction presents a reasonable alternative to immediate induction.

  1. Kunhwa K, et al. Urgent Cytoreductive Chemotherapy for Newly Diagnosed Patients with AML is Safe and Feasible and Facilitates Enrollment on Investigational Clinical Trials. 62nd ASH Annual Meeting, December 5-8, 2020. Abstract 1000.

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