Fitness classification and induction intensity selection in AML practice: A contemporary real-world cohort study.

Abstract

e18552 Background: Standard acute myeloid leukemia (AML) induction has historically relied on intensive cytarabine/anthracycline chemotherapy (IC). Many patients (pts), especially older adults or those with comorbidities or poor performance status are often not eligible for IC and face higher risk of treatment related toxicity and early mortality. Induction regimens have become increasingly individualized from improved supportive care and effective low intensity (LI) regimens, with recent trials supporting utility for LI regimens in broader patient populations. This highlights a need to explore current real-world treatment selection patterns. We retrospectively analyzed whether a predefined fitness stratification aligned with induction intensity selection and described early and 1-year mortality outcomes. Methods: We conducted a single-center retrospective cohort study of 70 treatment-naïve adults (age ≥ 18 years) with AML at a tertiary academic cancer center from 1/1/2019 to 12/31/2025. Fitness was classified using prespecified criteria: age ≥ 75 years, ECOG performance status ≥ 2, history of treated congestive heart failure or stable angina, chronic lung disease requiring baseline oxygen. IC included 7+3 or liposomal daunorubicin/cytarabine (CPX351). LI regimens included HMA ± venetoclax, or low dose cytarabine ± venetoclax. The primary endpoint was association between fitness and induction intensity selection. Secondary endpoints were 30- and 60-day mortality and 1-year overall survival (OS). Odds ratio (OR) and OS were reported descriptively. Results: Seventy total pts were included (median age 58 years); 36 pts were classified as fit and 34 as unfit. Induction intensity differed significantly by fitness. IC was administered in 78% (28/36) of fit and in 38% (13/34) of unfit pts (OR 5.65, 95% CI, 1.98–16.11, p = 0.0014), while LI regimen was selected in 22% (8/36) of fit and 62% (21/34) of unfit pts. Early mortality was low overall and did not differ by fitness at 30 days (2.8% [1/36] fit vs 0% [0/34] unfit, p = 1.0) or 60 days (2.8% [1/36] fit vs 8.8% [3/34] unfit, p = 0.35). Estimated 1-year OS was 82% (95% CI, 64%–92%) in fit and 60% (95% CI, 42%–75%) in unfit pts (log-rank p = 0.069). Conclusions: In a contemporary AML induction cohort, prespecified fitness classification strongly aligned with induction intensity selection, supporting fitness informed pathways in real-world decision making. Early mortality was low across fitness groups, potentially reflecting improved supportive care and risk adapted induction selection. 1-year OS numerically favored fit pts but did not reach significance, likely due to few events. These real-world data demonstrate current practice patterns and provide benchmarks for counseling and supportive care planning. Broader, large multicenter cohort studies with time-to-event analyses are needed to improve outcomes for adult AML patients.