P065 | AN ALTERED IRON PROFILE AT DIAGNOSIS IS RELATED TO HIGH RISK ACUTE MYELOID LEUKEMIA SUBSETS AND INFORMS CLINICAL OUTCOMES AND RESPONSE TO NON-INTENSIVE THERAPIES

Iron metabolism is deeply linked to the pathogenesis of acute myeloid leukemia (AML) and remains largely unexplored as a predictor of response to therapy. In this work we aimed at establishing an association between iron/inflammatory parameters at diagnosis and several parameters, including biological features and clinical outcomes. We conducted a single-centre retrospective analysis in intensively (IC) and non-intensively (NIC) treated AML patients. Iron and inflammatory parameters at diagnosis (ferritin/ transferrin saturation (TSAT)/transferrin/ free iron/C-reactive-protein (CRP)) were collected, dividing patients into an altered cohort (AC) and a non-altered cohort (NAC). The two cohorts were compared in terms of ELN22 and ELN24 risk classification categories, molecular and cytogenetic features, leukemic cell differentiation (monocytic/undifferentiated), frequency of extra-medullary disease at disease onset. Furthermore, we compared AC and NAC in terms of overall survival (OS), progression-free survival (PFS), complete remission (CR) rate, minimal residual disease (MRD) negativity, rate of clinically significant infections and rate of packed red blood cells (PRBCs) transfusions during induction. One hundred and six patients (n=106) were eligible and included in the study. Exclusion criteria included > 5 previous PRBC transfusions and clinically active infections. Among NIC patients, the AC group included a higher number of patients within high and intermediate ELN24 risk categories. In the whole population an altered iron laboratory profile at diagnosis was correlated with TP53 mutational status, presence of complex karyotype, MDS-related cytogenetic abnormalities and a monocytic phenotype. In IC and NIC patients, an altered iron profile at diagnosis was correlated with a higher requirement (>10) for PRBCs and a higher rate of infections during induction. Notably, in the NIC cohort a significantly higher rate of CR was observed in the NAC. OS did not differ according to alterations of iron parameters in IC patients, while in the NIC group OS and PFS were significantly different between AC and NAC (AC vs NAC 30 months OS: 60% vs 35%; p= 0,0007; Figure 1). With the limitations of a single center and retrospective study, our data show that an altered iron profile at diagnosis is related to high risk AML subsets and may inform clinical outcomes and response to non-intensive therapies.