Hematology AdvisorDAGO2 Superior to CPX-351 for Older Patients With Non-Adverse-Risk AML

A randomized study in Blood compared DAGO2 (daunorubicin/cytarabine plus fractionated gemtuzumab ozogamicin) against CPX-351 in 439 previously untreated AML patients aged 60 or older without adverse-risk cytogenetics. 3-year overall survival reached 52% with DAGO2 versus 35% with CPX.

Clinical Considerations

• 3-year event-free survival was 34% with DAGO2 versus 27% with CPX, with overall survival favoring DAGO2 by 17 percentage points
• Initial complete remission rates favored DAGO2 at 60% versus 47.5% for CPX after the first chemotherapy course
• Intensified CPX-351 dosing did not improve outcomes over standard CPX, raising questions about dose-escalation strategy in this population
• Population was primarily de novo AML with intermediate-risk cytogenetics; results may not extrapolate to adverse-risk or secondary AML

Practice Applications

• Consider DAGO2 as a preferred intensive regimen for fit older AML patients without adverse-risk cytogenetics
• Recognize CPX-351’s strongest evidence remains in therapy-related and AML with myelodysplasia-related changes, not the population studied here
• Interpret results within the trial’s intermediate-risk de novo AML population before broader application
• Integrate MRD status after first course into decisions about intensification

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