Eprenetapopt Plus Azacitidine After Allogeneic Hematopoietic Stem-Cell Transplantation for TP53-Mutant Acute Myeloid Leukemia and Myelodysplastic Syndromes
Abstract
PURPOSE: Outcomes are poor in TP53-mutant (m TP53) acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS), even after allogeneic hematopoietic stem-cell transplant (HCT). Eprenetapopt (APR-246) is a first-in-class, small-molecule p53 reactivator. PATIENTS AND METHODS: We conducted a phase II, multicenter, open-label trial to assess efficacy and safety of eprenetapopt combined with azacitidine as maintenance therapy after HCT (ClinicalTrials.gov identifier: NCT03931291 ). Patients with m TP53 MDS or AML received up to 12 cycles of eprenetapopt 3.7 g once daily intravenously on days 1-4 and azacitidine 36 mg/m 2 once daily intravenously/subcutaneously on days 1-5 in 28-day cycles. The primary outcomes were relapse-free survival (RFS) and safety. RESULTS: Of the 84 patients screened for eligibility before HCT, 55 received a transplant. Thirty-three patients ultimately received maintenance treatment (14 AML and 19 MDS); the median age was 65 (range, 40-74) years. The median number of eprenetapopt cycles was 7 (range, 1-12). With a median follow-up of 14.5 months, the median RFS was 12.5 months (95% CI, 9.6 to not estimable) and the 1-year RFS probability was 59.9% (95% CI, 41 to 74). With a median follow-up of 17.0 months, the median overall survival (OS) was 20.6 months (95% CI, 14.2 to not estimable) and the 1-year OS probability was 78.8% (95% CI, 60.6 to 89.3). Thirty-day and 60-day mortalities from the first dose were 0% and 6% (n = 2), respectively. Acute and chronic (all grade) graft-versus-host disease adverse events were reported in 12% (n = 4) and 33% (n = 11) of patients, respectively. CONCLUSION: In patients with m TP53 AML and MDS, post-HCT maintenance therapy with eprenetapopt combined with azacitidine was well tolerated. RFS and OS outcomes were encouraging in this high-risk population.
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Recent maintenance data of APR-246 + AZA post allo-HCT showed a median RFS of 12.5 months and OS of 20.6 months.
“recent maintenance data of APR‐246 + AZA post allo‐HCT with a median RFS of 12.5 months and OS of 20.6 months.”
From Long‐term follow‐up and combined Phase 2 results of eprenetapopt and azacitidine in patients with <i>TP53</i> mutant MDS/AML (2025) · cites this paper as [47]
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“47 Additional development of APR ‐ 246 has merit to identify the population who benefits most as well as novel combinations.”
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- Authors
- Mishra, A., Tamari, R., DeZern, A. E., Byrne, M. T., Gooptu, M., Chen, Y.-B., Deeg, H. J., Sallman, D., Gallacher, P., Wennborg, A., Hickman, D. K., Attar, E. C., & Fernandez, H. F.
- Affiliations
- Moffitt Cancer Center (US)
- Memorial Sloan Kettering Cancer Center (US)
- Johns Hopkins University (US)
- Vanderbilt University Medical Center (US)
- Harvard University (US)
- Massachusetts General Hospital (US)
- Fred Hutch Cancer Center (US)
- Aprea Therapeutics, Inc. (United States) (US)
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2022-12-01
- Volume
- 40
- Issue
- 34
- Pages
- 3985-3993
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W4285043725
- Cited by
- 146
- References
- 27
- Citations by year
- 2026: 21 · 2025: 35 · 2024: 34 · 2023: 47 · 2022: 7 · 2014: 1
- FWCI
- 22.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hematology › Acute Myeloid Leukemia Research
- Health Sciences › Medicine › Hematology › Hematopoietic Stem Cell Transplantation
- Health Sciences › Medicine › Oncology › Cancer-related Molecular Pathways
- Keywords
- APR-246, azacitidine, TP53 mutation, acute myeloid leukemia, myelodysplastic syndrome, allogeneic hematopoietic stem cell transplantation, maintenance therapy, relapse-free survival, overall survival, graft-versus-host disease, adverse events
- MeSH terms
- Aged, Antineoplastic Agents, Azacitidine, Graft vs Host Disease, Humans, Myelodysplastic Syndromes, Recurrence, Leukemia, Myeloid, Acute, Tumor Suppressor Protein p53, Hematopoietic Stem Cell Transplantation
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