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Adding tyrosine kinase inhibitors to chemo may upgrade AML with BCR::ABL1 from high-risk to intermediate-risk.

AML harboring BCR::ABL1 is classified as adverse-risk by European LeukemiaNet guidelines, but this classification was established before TKIs were routinely added to treatment. This real-world study of 57 BCR::ABL1 AML patients from the Spanish PETHEMA registry assessed whether TKI addition changes…

Dan Manning

Dan Manning

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Adding tyrosine kinase inhibitors to chemo may upgrade AML with BCR::ABL1 from high-risk to intermediate-risk.

Adding tyrosine kinase inhibitors to chemo may upgrade AML with BCR::ABL1 from high-risk to intermediate-risk.

AML harboring BCR::ABL1 is classified as adverse-risk by European LeukemiaNet guidelines, but this classification was established before TKIs were routinely added to treatment. This real-world study of 57 BCR::ABL1 AML patients from the Spanish PETHEMA registry assessed whether TKI addition changes prognosis.

Patients who received TKI had better relapse-free survival (median not reached vs. 7.6 months without TKI, p=0.029). Comparison with the broader PETHEMA cohort showed TKI-treated BCR::ABL1 AML patients had OS similar to intermediate-risk patients—not adverse-risk. No independent prognostic factors were identified in Cox regression.

Though based on small numbers, this supports re-classification of BCR::ABL1 AML to intermediate-risk when TKI is used, which has treatment planning implications.

Key Findings

  • TKI addition improved relapse-free survival (median not reached vs. 7.6 months without TKI, p=0.029)
  • TKI-treated BCR::ABL1 AML had OS similar to intermediate-risk patients in PETHEMA cohort
  • 57 patients with BCR::ABL1 AML from Spanish registry
  • Current adverse-risk classification may be outdated in the TKI era
  • Results support re-classification to intermediate-risk, though larger studies are needed

Implications

BCR::ABL1 AML patients receiving TKI may warrant reclassification to intermediate-risk, potentially affecting clinical trial enrollment criteria, treatment intensity decisions, and transplant indications. TKI should be added to treatment for all BCR::ABL1 AML patients.

Caveats

Small retrospective study (n=57, only 15 received TKI); abstract-only. Selection bias likely in TKI receipt. Single country (Spain). Larger prospective studies are needed before guideline changes. Overall survival did not reach statistical significance (p=0.28).

Source: Cancer — 2026-04-15

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