QUAZAR just published @NEJM. Maintenance oral AZA resulted in ~10 months longer OS in AML patients in first remission, results should be interpreted with caution:
Difference in survival can be related to different ttt at time of progression
- presented last year #ASH19
#AML

- Age>=55 (Median: 68 yrs)
- ttt group at randomization similar, AEs okay, and QoL is not worse ( not better though)
- where is the problem?
More patients in placebo arm got transplant(supposed to be transplant in-eligible) and more intense therapy at progression.

- Transplant in-eligible, though 15 pts (6%) in AZA group got transplant vs. 32 pts (14%) in placebo group
- Major problem is ttt at progression: 8% higher transplant in placebo arm ( transplant related mortality?)
- more intensive chemo for elderly= higher mortality
#AML

- Causes for mortality: chemo, transplant, disease...this is super important
- Exact regimens at relapse was not provided
- I still cannot understand how oral AZA is different from parental AZA( authors cited article of 8 AML pts to suggest difference)
#AML

Last ethical question: if patients are getting transplant and high dose chemotherapy at progression, why they didn’t get it at the first remission?

- All patients were intermediate risk at least at time of diagnosis and the only curative option is transplant- Interesting #AML