Gemtuzumab Ozogamicin in Treating Acute Myeloid Leukemia Subgroups

By Patrick Daly - Last Updated: November 10, 2021

In a systematic review and meta-analysis, researchers assessed the efficacy and safety of gemtuzumab ozogamicin (GO) in treating patients with subtypes of acute myeloid leukemia (AML). They found that GO has the potential to improve prognosis for several groups. Their findings were published in Frontiers in Immunology.

The authors, Qingyu Xu, MD, and colleagues, reported that AML could be an especially effective treatment option “for those under age 70, with de novo AML, with positive expression of CD33, with NPM1 mutation, without FLT3-ITD mutation, and with low-/intermediate-risk karyotypes.”

Investigators searched the PubMed, Embase, Cochrane, and Chinese databases for randomized controlled trials (RCTs), and retrospective cohort studies that compared outcomes between GO and non-GO groups in patients with AML. Pooled effect sizes and 95% confidence intervals (CI) were calculated using random-effects models. Relative risk (RR) was used for estimating complete remission (CR), early death, and toxicity.

A total of 15 RCTs, and 15 retrospective cohort studies were identified with 4,768 GO cases and 6,566 control cases. Observers noted that GO tended to improve CR (RR 0.95, p = 0.084), and significantly improved survival (overall survival: HR 0.86, p = 0.003; event-free survival: HR 0.86, p = 0.015; relapse-free survival: HR 0.83, p = 0.001; cumulative incidence of relapse: HR 0.82, p < 0.001).

Combining GO with induction therapy (p ? 0.011), and using a lower (less than 6 mg/m2) dose of GO (p ? 0.03) both improved survival. Notably, GO was related to increased risk of early death at a higher dose (6 mg/m2 or more) (RR 2.01, p = 0.005), hepatic-related adverse effects (RR 1.29, p = 0.02), and a tendency of higher risk for hepatic veno-occlusive disease, or sinusoidal obstruction syndrome (RR 1.56, p = 0.072).

Following review, the authors concluded that combining GO with other chemotherapies seemed beneficial relative to chemotherapy alone. They suggested that further studies, both involving subgroups and evaluating the best treatment regimen to combine with GO, are needed.