Multinational retrospective study of addition of BCR-ABL1 TKI to intensive chemotherapy for de novo BCR::ABL1+ acute myeloid leukemia

A multinational retrospective study evaluated the impact of adding a BCR-ABL1 tyrosine kinase inhibitor (TKI) to intensive chemotherapy (IC) on the outcome of de novo BCR::ABL1+ acute myeloid leukemia (AML). The study included 212 adult AML patients with ≥20% bone marrow blasts; BCR-ABL1+ or t(9:22)(q34.1; q11.2), no history of chronic myeloid leukemia, and no prior exposure to BCR-ABL1 TKI. Eight-nine patients received IC alone and 123 received IC+TKI. Complete remission (CR) or CR with incomplete hematologic recovery (CRi) was achieved in 68% of IC patients and 89% of IC+TKI patients (p<0.0001). With a median follow-up of 66.7 months, median overall survival (OS) was 20.5 months with IC and not reached with IC+TKI. Five-year OS rates were 38.5% with IC and 62.9% with IC+TKI (p<0.0001). In multivariate analysis, addition of TKI to IC was significantly and independently associated with improved CR/CRi rate (OR 4.74; p<0.0001) and OS (HR 0.40; p<0.0001). The authors conclude that the outcome of de novo BCR::ABL1+ AML is strongly improved by addition of TKI to IC.