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Jean-Jacques Kiladjian, MD, PhD, Hôpital Saint-Louis and Paris Diderot University

Disclosure: Please see Session Details (link below).

Background:We and others have shown that IFN therapy provides several benefits to MPN patients (pts) including molecular responses and possible long-term remissions off cytoreductive therapy (CRT). However, little is known about outcomes after IFN discontinuation, and the clinical relevance of achievement of molecular response is disputed.

Methods:We collected all cases of MPN pts followed in our institution who received IFN therapy since 2000, and who discontinued treatment. Cumulative incidences of relapse, hematological transformation and thrombosis were based on competing risks estimator. Survival curves and event free survival (EFS, i.e. time to first event including transformation, thrombosis and death) curves from IFN start were plotted based on the Kaplan Meier method. Univariate logistic models were used to predict complete hematological response (CHR) without any CRT; Cox models were used to predict EFS, and cause-specific hazard of relapse. Multivariable models were then fitted, with a stepwise selection procedure. All tests were two-sided with p-values =0.05 denoting statistical significance.

Results:A total of 149 out of 333 IFN treated MPN pts had discontinued therapy at time of analysis. 78 had polycythemia vera (PV), 61 essential thrombocythemia (ET), and 10 myelofibrosis (MF). Reasons for choosing IFN in these 149 pts were young age in 75 (50%), resistance / intolerance to previous therapies in 40 (27%), pregnancy in 4 and other in 30. Median age at IFN start was 49.5 years [interquartile range, IQR: 39-60] and median [IQR] time since diagnosis of MPN was 2 years [0.6-6.8]. 64 pts had a history of vascular event.

123 pts were JAK2V617F+, 15 had CALR, 5 MPL and 1 JAK2 exon 12 mutations, and 5 were triple-neg. Among 47 pts tested by NGS, 15 had additional mutations.

Best response to IFN was CHR in 123 (83%), partial response (PR) in 16, and failure in 10 pts. Reasons for IFN discontinuation were toxicity in 79 (53%), prolonged hematological CHR in 52 (35%), and other in 18. Median IFN treatment duration was 28.3 months (mos) [10-45]. At discontinuation, 114 (77%) pts were in CHR, 17 (11%) in PR, and IFN failed in 18 (12%).

At IFN start, median mutant allele burden were 25% [IQR: 15-48] and 38% [34-43] for JAK2 and CALR resp. At IFN discontinuation, median %JAK2 and %CALR had decreased to 10% [3-25], and 13.5% [6-43], resp.

At last follow up, 109 (73%) pts were alive in CHR for a median time after IFN discontinuation of 42 mos [23-58], including 46 (42%) without CRT after 33 mos [19-53]. Based on a multivariable logistic model, the CHR without CRT was associated with mutant allele burden at IFN discontinuation (OR=0.95, 95%CI, 0.95-0.96, P=0.034), stopping for toxicity reason (OR= 0.82, 95%CI, 0.75-0.89, P= 0.009), and cumulative dose of IFN (OR=1.01/mg, 95%CI, 1.003-1.02, P= 0.012).

Hematological relapse occurred in 49 pts. IFN was restarted in 25 of them and all achieved hematological response, including 72% CHR. Based on a multivariable Cox model, the cause-specific hazard of relapse was decreased in ET (HR= 0.4, 95%CI, 0.2-0.8; P= 0.013) while increased with the baseline WBC count (HR= 1.07, 95%CI, 1.02-1.14, P= 0.011).

Ten pts had a thrombotic event after IFN, with a 5 year cumulative incidence of 10% (95%CI, 4-16%). A total of 11 pts transformed to MF, 3 to MDS / AML, and 2 from ET to PV; the 5-year cumulative incidence of transformation was 3.8% (95%CI, 0.4-7.2%). Six patients had died (4 after transformation). Overall, 25 patients developed a thrombosis, transformation or death. The 5- and 10-year EFS were 92% (95%CI, 87-97) and 72% (95%CI, 62-84), resp. In multivariate model, only time between diagnosis and IFN start (HR=1., 95%CI, 1.002-1.016, P=0.011) and mutant allele burden at IFN discontinuation (HR=1.03, 95%CI, 1.016-1.048, P<0.0001)<

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by Ruben A. Mesa,

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Ruben A. Mesa, MD @mpdrc¡]Professor and Chair, Hematology & Medical Oncology: Deputy Director Mayo Clinic Cancer Center )

¡§2 major interferon studies in upfront in MPN, both find INF non inferior to HU in first year. Need longer term data! #ASH16 #mpnsm

MPD RC 112 at 12M peg inf non inf by marrow and molecular response, may be too soon for difference #mpnsm #ASH16 pic.twitter.com/zdMipswd41

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Paper No: 3106

Outcomes of Patients with Myeloproliferative Neoplasms (MPN) after Interferon-Alpha (IFN) Therapy Discontinuation

Jean-Jacques Kiladjian, MD, PhD, Hôpital Saint-Louis and Paris Diderot University

Disclosure: Please see Session Details (link below).

Background:We and others have shown that IFN therapy provides several benefits to MPN patients (pts) including molecular responses and possible long-term remissions off cytoreductive therapy (CRT). However, little is known about outcomes after IFN discontinuation, and the clinical relevance of achievement of molecular response is disputed.

Methods:We collected all cases of MPN pts followed in our institution who received IFN therapy since 2000, and who discontinued treatment. Cumulative incidences of relapse, hematological transformation and thrombosis were based on competing risks estimator. Survival curves and event free survival (EFS, i.e. time to first event including transformation, thrombosis and death) curves from IFN start were plotted based on the Kaplan Meier method. Univariate logistic models were used to predict complete hematological response (CHR) without any CRT; Cox models were used to predict EFS, and cause-specific hazard of relapse. Multivariable models were then fitted, with a stepwise selection procedure. All tests were two-sided with p-values =0.05 denoting statistical significance.

Results:A total of 149 out of 333 IFN treated MPN pts had discontinued therapy at time of analysis. 78 had polycythemia vera (PV), 61 essential thrombocythemia (ET), and 10 myelofibrosis (MF). Reasons for choosing IFN in these 149 pts were young age in 75 (50%), resistance / intolerance to previous therapies in 40 (27%), pregnancy in 4 and other in 30. Median age at IFN start was 49.5 years [interquartile range, IQR: 39-60] and median [IQR] time since diagnosis of MPN was 2 years [0.6-6.8]. 64 pts had a history of vascular event.

123 pts were JAK2V617F+, 15 had CALR, 5 MPL and 1 JAK2 exon 12 mutations, and 5 were triple-neg. Among 47 pts tested by NGS, 15 had additional mutations.

Best response to IFN was CHR in 123 (83%), partial response (PR) in 16, and failure in 10 pts. Reasons for IFN discontinuation were toxicity in 79 (53%), prolonged hematological CHR in 52 (35%), and other in 18. Median IFN treatment duration was 28.3 months (mos) [10-45]. At discontinuation, 114 (77%) pts were in CHR, 17 (11%) in PR, and IFN failed in 18 (12%).

At IFN start, median mutant allele burden were 25% [IQR: 15-48] and 38% [34-43] for JAK2 and CALR resp. At IFN discontinuation, median %JAK2 and %CALR had decreased to 10% [3-25], and 13.5% [6-43], resp.

At last follow up, 109 (73%) pts were alive in CHR for a median time after IFN discontinuation of 42 mos [23-58], including 46 (42%) without CRT after 33 mos [19-53]. Based on a multivariable logistic model, the CHR without CRT was associated with mutant allele burden at IFN discontinuation (OR=0.95, 95%CI, 0.95-0.96, P=0.034), stopping for toxicity reason (OR= 0.82, 95%CI, 0.75-0.89, P= 0.009), and cumulative dose of IFN (OR=1.01/mg, 95%CI, 1.003-1.02, P= 0.012).

Hematological relapse occurred in 49 pts. IFN was restarted in 25 of them and all achieved hematological response, including 72% CHR. Based on a multivariable Cox model, the cause-specific hazard of relapse was decreased in ET (HR= 0.4, 95%CI, 0.2-0.8; P= 0.013) while increased with the baseline WBC count (HR= 1.07, 95%CI, 1.02-1.14, P= 0.011).

Ten pts had a thrombotic event after IFN, with a 5 year cumulative incidence of 10% (95%CI, 4-16%). A total of 11 pts transformed to MF, 3 to MDS / AML, and 2 from ET to PV; the 5-year cumulative incidence of transformation was 3.8% (95%CI, 0.4-7.2%). Six patients had died (4 after transformation). Overall, 25 patients developed a thrombosis, transformation or death. The 5- and 10-year EFS were 92% (95%CI, 87-97) and 72% (95%CI, 62-84), resp. In multivariate model

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§ë¼v¤ùtitle: Complete Hematologic Response at 12 months

§ë¼v¤ùconclusion: non-inferiority is demonstrated, p=0.0028

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#ASH16 clinical relevance of jak2 allele burden reduction with IFN http://ativsoftware.com/appinfo.php?page=Session&project=ASH16&server=ep70.eventpilotadmin.com&id=89558 ¡K

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Proud-PV First phase 3 comparing hydrea to IFN reached its endpoint! #mpnsm

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(¤@)475 Final Results from PROUD-PV a Randomized Controlled Phase 3 Trial Comparing Ropeginterferon Alfa-2b to Hydroxyurea in Polycythemia Vera Patients

Conclusions: This is the first phase III trial formally assessing efficacy, safety and tolerability of Ropeginterferon alfa-2b versus HU. Both cohorts are followed-up for prolonged treatment duration, and it is expected that the currently available and emerging data will establish the role of Ropeginterferon alfa-2b as first-line treatment for PV.

(¤G)479 Interim Analysis of the Myeloproliferative Disorders Research Consortium (MPD-RC) 112 Global Phase III Trial of Front Line Pegylated Interferon Alpha-2a Vs. Hydroxyurea in High Risk Polycythemia Vera and Essential Thrombocythemia

Conclusions:

This interim analysis does not show a clear difference in primary endpoint of CHR between HU and PEG. A comparative analysis of the quality of life and symptom burden will provide further insight into the tolerability of these agents (Mesa et al ASH 2016). The final results of this pivotal trial will provide necessary data required to firmly establish the optimal first line therapy for patients with high risk ET/PV.

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mean mutant JAK2 allele burden went from 42,5% to 28,7%. ³o³¡¤ÀÀ³¸Ó¬OPV©Ò°^Äm,³o¼ËÁÙ¤£¯à§@¬° first-line treatment for PV.¶Ü?

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What is old is new again, and the resurgence in interest in an older therapy, interferon, has made a splash at the annual meeting this year. The MPN field eagerly awaits the results of two key phase III studies being presented here in San Diego: ropeginteron à-2b versus hydroxyurea for patients with higher risk PV(the PROUD-PV study, abstract #475), and the MPD Research Consortium global study of pegylated interferon versus hydroxyurea in patients with high risk PV and essential thrombocytopenia(ET; MPD-RC 112, abstract #479).

¡§The data from these studies will be important and impactful as we evaluate how long-acting interferon use in PV is viewed in the future,¡¨ explained Dr. Mesa. ¡§Currently it has been largely used in academic centers or in patients with more refractory disease, particularly in the United States. Both the data and the nuances from these studies will be important in terms of seeing the effect on front-line treatment of patients with PV in the near future.¡¨

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©ó105¦~10¤ë21¤é©ó±À¯S«ü¥X¡AExciting meeting in Vienna about the ropeginterferon studies. Results expected to be presented @ASH_hematology meeting ¡C¦P®É¡A¸Ó¾ÇªÌ¥ç¦C¤J°Ñ¥[12¤ë4¤éASH·|ijAOP¹Î¶¤½s¸¹15¸¹Âå¥Í¤§¤@(Jean-Jacques Kiladjian, MD, PhD15)¡C

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(¤@)Treatment with Ropeginterferon alfa 2b is expected to be safe and effective in the majority of patients and to be superior to hydroxyurea.

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