Adults with secondary acute myeloid leukemia (sAML) face a significant treatment burden with prolonged time in hospital impacting their quality of life. For patients with sAML who are eligible for intensive chemotherapy (IC), the European LeukemiaNet 2022 guidelines recommend CPX-351, a fixed-duration IC regimen (1-4 treatment cycles). For patients who are unsuitable for IC, continuous treatment with venetoclax plus azacitidine (VEN-AZA) is recommended. Due to their different treatment schedules, CPX-351 and VEN-AZA have contrasting short- and long-term burdens on patients and healthcare systems. A recent study reported that overall survival and percentage (%) of days at home were superior with conventional 7+3 (despite longer initial hospital length stay) vs VEN-AZA (Matthews AH et al. Am J Hematol. 2023;98(8):1254-1264). However, the long-term time spent at home with CPX-351 vs VEN-AZA in a non-US healthcare setting remains unexplored. This study compared the time patients with sAML spent at home within their front-line (1L) treatment with CPX-351 or VEN-AZA in routine clinical practice in England.

This retrospective population-based cohort study included adults (≥18 years) with sAML (therapy-related AML or AML with prior myelodysplastic syndrome/chronic myelomonocytic leukemia) who received 1L CPX-351 or 1L VEN-AZA in a real-world setting in England between October 01, 2018, and April 30, 2023. Patient records were sourced from the Cancer Analysis System database via the National Cancer Registration and Analysis Service. Time at home, defined as % of days without any record of interaction with the secondary healthcare system, excluding accident and emergency data, was analyzed monthly from 1L treatment initiation until earliest of death, censoring, or second-line treatment. Hematopoietic cell transplantation (HCT) was considered part of 1L treatment. To adjust for confounding factors, results were stratified by age, HCT status, and presence of comorbidities.

This analysis included 278 patients treated with CPX-351 (median age: 64 years) and 592 treated with VEN-AZA (median age: 74 years), with 38.5% (107/278) and 4.9% (29/592) of patients receiving HCT, respectively. Median follow-up time from AML diagnosis was 10.9 months for CPX-351 and 8.8 months for VEN-AZA. In the overall population, the mean % time at home was 70.1% for CPX-351 vs 69.0% for VEN-AZA, and for patients who survived >6 months, it was 86.7% vs 77.7%, respectively. During the first 3 months of treatment, patients treated with VEN-AZA vs CPX-351 had higher % time at home (mean: 50.3% [95% CI: 49.7, 51.0] vs 29.4% [95% CI: 28.6, 30.2]) but both treatments reached equipoise at ~7 months (74.5% and 74.6%, respectively). From months 8 to 36, a consistently higher % time at home was observed in patients treated with CPX-351 (range: 80.4% to 97.6%) vs VEN-AZA (range: 74.7% to 90.2%), typically ~5-10% higher per month (monthly difference range: +3.5 to +11.9%). When restricted to patients ≥60 years, the same overall pattern was evident with a short-term benefit in the first 3 months for VEN-AZA (mean % time at home: 51.0% [95% CI: 50.4, 51.7] vs 29.5% [95% CI: 28.6, 30.4]) but from months 8 to 36, higher % time at home was observed with CPX-351 (range: 79.8% to 98.0%) vs VEN-AZA (range: 75.0% to 89.8%), also typically ~5-10% higher per month (monthly difference range: +2.6 to +12.2%). Similar results were also seen in patients with or without comorbidities and in patients who did not receive HCT. In patients who received HCT, the overall mean % time at home was 75.6% for CPX-351 vs 70.6% for VEN-AZA.

Time at home is an important consideration for patient experience and treatment choice. This real-world analysis quantifies the acute and chronic burden on patients with sAML when treated with CPX-351 or VEN-AZA. The data highlighted that during early months of treatment, patients with sAML treated with VEN-AZA spent more days at home vs CPX-351; however, this benefit ended at approximately 7 months, and after this, patients treated with CPX-351 consistently spent more days at home per month and overall. This aligns with previous findings that IC results in more days spent at home vs VEN plus hypomethylating agents, and this benefit is likely to increase with successful implementation of outpatient delivery models for IC. These findings are important for informed 1L treatment decisions for sAML between patients, carers, and their healthcare team.

This content is only available as a PDF.
2025
Sign in via your Institution