C089 | REAL-LIFE OUTCOMES IN PATIENTS WITH ACUTE MYELOID LEUKEMIA SECONDARY TO MYELOPROLIFERATIVE NEOPLASIA: RESULTS OF MULTICENTRIC ENEA-STUDY

Background: Acute Myeloid Leukemia secondary to Myeloproliferative Neoplasms (sAML-MPN) poses significant challenges due to poor prognosis and limited treatment options. Limited data exist on the impact of first-line strategies and prognostic factors influencing survival. Methods: We performed a retrospective analysis to evaluate clinical characteristics, first-line treatment strategies, treatment responses, survival outcomes, and predictive factors in patients with sAML-MPN. A total of 138 patients from 19 Italian Centers were analyzed. Patients were treated according to clinical practice. Results: Median age at AML was 69.3 years, 62% of patients were male. Population characteristics are summarized in Table 1 and 2. First-line treatments were HMAs+VEN (40.6%), CHT (37.7%), and HMAs alone (21.7%). Among CHT patients, FLA-IDA–like regimens were most common (56%), followed by CPX-351 (23%). Overall cCR was 46%, with no significant differences among HMAs (30%), CHT (53.8%), and HMAs+VEN (48.2%) (p=0.107). Only ECOG-PS of 0-1 (OR 2.2, p = 0.017) showed independent predictive value for response. HSCT was performed in 25.4% of the cohort (n=35). The CHT group had the highest HSCT rate (n=27/52, 52%) compared to HMAs+VEN (n=4/56, 7%) and HMAs (n=4/26, 13%) (p = 0.001). Non-HSCT patients were older (61.7 vs. 72.5 years, p < 0.001); no other difference was observed with HSCT patients. Median OS (mOS) in all cohort was 10.1 months (95% CI: 7.7–12.4). Primary cause of death was progression (56%), followed by infections (27%). Median OS by treatment was 12.8 months for CHT, 9.5 months for HMAs + VEN, and 7.8 months for HMAs (p = 0.043), but no difference was observed after HSCT adjustment (p = 0.18). Achieving cCR significantly improved mOS (14.7 vs. 6.7 months, p=0.001). Notably, non-responsive patients to first-line therapy who proceeded to HSCT had similar survival to those who achieved cCR (Figure A). This finding was confirmed in a CHT subgroup analysis. Multivariate analysis confirmed HSCT, cCR, and HR karyotype as independent survival predictors. In the CHT group, only HSCT was predictive (Figure B). Conclusion: The CHT subgroup showed the longest mOS, especially in HSCT patients. The HMAs+VEN regimen had encouraging response rates, but survival benefits were less significant, likely due to higher median age and lower transplant rate. Notably, even patients not reaching cCR benefited from HSCT, highlighting its potential to overcome adverse prognostic factors.