Association between gene mutations and outcomes in Japanese high-risk AML patients: a phase 1/2 study of NS-87/CPX-351

Abstract

This phase 1/2 study investigated the association between genetic characteristics and outcomes for NS-87/CPX-351 in Japanese patients with high-risk acute myeloid leukemia. Blood samples collected from 29 patients were analyzed using a 70-gene next-generation sequencing panel. The most frequently mutated genes were TP53 (44.8%), TET2 (24.1%), DNMT3A (13.8%), and NRAS (13.8%). The rates of composite complete remission (CRc; complete remission [CR] or CR with incomplete hematologic recovery [CRi]) were comparable between patients with and without mutations in TP53, TET2, DNMT3A, and NRAS (P = 0.571 for all). Notably, patients with TP53 mutations had a similar CRc rate (69.2% vs. 56.3%), but shorter overall survival (OS), event-free survival (EFS), and relapse-free survival (RFS) compared to patients with wild-type TP53 (median OS: 7.43 vs. 18.18 months; P = 0.108, median EFS: 2.43 vs. 6.28 months; P = 0.012, median RFS: 1.48 vs. 10.19 months; P = 0.012). In conclusion, no gene mutations directly associated with the efficacy of NS-87/CPX-351 were found. While NS-87/CPX-351 achieved remission even in patients with TP53 mutations, relapse risk was higher in these patients. Therefore, it is advisable to consider treatment strategies such as early transplantation after achieving remission with NS-87/CPX-351, especially in patients with TP53 mutations.

Keywords: TP53 mutations; Acute myeloid leukemia; CPX-351; NGS.

Fig. 1

Genetic landscape of 29 patients with high-risk AML. The presence of CR/CRi (red), poor risk cytogenetics (CG) (green), complex (complex karyotypes) (green), and indicated mutations (navy blue) are displayed for each patient. The number of mutations in each patient is shown in the chart at the top. The frequency (%) of the mutations is shown to the right of the plot. t-AML therapy-related AML