Addition of the nuclear export inhibitor selinexor to standard intensive treatment for elderly patients with acute myeloid leukemia and high risk myelodysplastic syndrome.

Publikation

Addition of the nuclear export inhibitor selinexor to standard intensive treatment for elderly patients with acute myeloid leukemia and high risk myelodysplastic syndrome.

Wissenschaftlicher Artikel/Review - 22.07.2022

Janssen J J W M, Löwenberg Bob, Manz M, Biemond B J, Westerweel P E, Klein S K, Fehr M, Sinnige H A M, Efthymiou Anna, Legdeur M C J C, Pabst T, Gregor M, van der Poel M W M, Deeren Dries, Tick L W, Jongen-Lavrencic Mojca, van Obbergh F, Boersma R S, de Weerdt Okke, Chalandon Yves, Heim D, Spertini Olivier, van Sluis G, Graux Carlos, Stüssi G, van Norden Y, Ossenkoppele G J

Zitation

Janssen J, Löwenberg B, Manz M, Biemond B, Westerweel P, Klein S, Fehr M, Sinnige H, Efthymiou A, Legdeur M, Pabst T, Gregor M, van der Poel M, Deeren D, Tick L, Jongen-Lavrencic M, van Obbergh F, Boersma R, de Weerdt O, Chalandon Y, Heim D, Spertini O, van Sluis G, Graux C, Stüssi G, van Norden Y, Ossenkoppele G. Addition of the nuclear export inhibitor selinexor to standard intensive treatment for elderly patients with acute myeloid leukemia and high risk myelodysplastic syndrome. Leukemia 2022; 36:2189-2195.

Art

Wissenschaftlicher Artikel/Review (Englisch)

Zeitschrift

Leukemia 2022; 36

Veröffentlichungsdatum

22.07.2022

eISSN (Online)

1476-5551

Seiten

2189-2195

Kurzbeschreibung/Zielsetzung

Treatment results of AML in elderly patients are unsatisfactory. In an open label randomized phase II study, we investigated whether addition of the XPO1 inhibitor selinexor to intensive chemotherapy would improve outcome in this population. 102 AML patients > 65 years of age (median 69 (65-80)) were randomly assigned to standard chemotherapy (3 + 7) with or without oral selinexor 60 mg twice weekly (both arms n = 51), days 1-24. In the second cycle, cytarabine 1000 mg/m twice daily, days 1-6 with or without selinexor was given. CR/CRi rates were significantly higher in the control arm than in the investigational arm (80% (95% C.I. 69-91%) vs. 59% (45-72%; p = 0.018), respectively). At 18 months, event-free survival was 45% for the control arm versus 26% for the investigational arm (Cox-p = 0.012) and overall survival 58% vs. 33%, respectively (p = 0.009). AML and infectious complications accounted for an increased death rate in the investigational arm. Irrespective of treatment, MRD status after two cycles appeared to be correlated with survival. We conclude that the addition of selinexor to standard chemotherapy does negatively affect the therapeutic outcome of elderly AML patients. (Netherlands Trial Registry number NL5748 (NTR5902), www.trialregister.nl ).