Longer follow-up is required to determine efficacy but this approach is of particular interest for treatment of APL in medium and low income countries. AML-219 Improved Responses with Azacitidine Compared to Decitabine in Patients with Acute Myeloid Leukemia in Pa- tients ‡70 with Poor-Risk Cytogenetics Chetasi Talati  , 1 Andrew Kuykendall, 1 Najla Al-Ali, 2 Rami Komrokji, 2 Eric Padron, 2 David Sallman, 2 Alan List, 2 Kendra Sweet, 2 Martine Extermann, 2 Jeffrey Lancet 2 1 H. Lee Moffitt Cancer Center /University of South Florida, Tampa, United States; 2 H. Lee Moffitt Cancer Center, Tampa, United States Background: Therapeutic options for patients age 70 years with acute myeloid leukemia (AML) are extremely limited and comprise mainly of clinical trials and hypomethylating agents (HMAs) including azacitidine (AZA) and decitabine (DEC). Thus we aim to explore clinical outcomes when treated with AZA compared to DEC. Methods: Retrospective chart review was performed to collect and analyze the clinical data for 252 patients age 70 years with diagnosis of AML treated with HMAs at Moffitt Cancer Center between 2003 and 2016. Kaplan-Meier analysis was performed to calculate overall survival (OS) with log-rank test used to calculate significance defined by p value <0.05. Results: DEC was utilized in 35.3% of the patients (n¼89) compared to AZA in 63.7% of the patients (n¼163) as a frontline treatment. Baseline characteristics are outlined in Table 1. OS of DEC cohort and AZA cohort were 11.13 vs. 15.68 months(mo) respectively (p¼0.199). Per National Comprehensive Cancer Network cytogenetics risk category of AML, patients with favorable- risk cytogenetics (FRC) were 0% vs. 1.8%, intermediate-risk cytogenetics (IRC) were 57.3% vs. 56.44%, and poor-risk cytogenetics (PRC) were 32.6% vs. 34.4% in DEC and AZA cohorts respectively. OS in IRC cohort treated with DEC was 16.5mo vs.19.3mo in AZA cohort (p¼0.432). However, the OS in PRC cohort treated with AZA was significantly greater at 10.83mo compared to 6.67mo when treated with DEC (p¼0.028). Upon further refinement of PRC cohort into harboring monosomal karyotype (MK) and non-monosomal karyotype (NMK), cohort with NMK (n¼32) had superior OS of 13.63mo compared to 8.34mo in MK cohort (n¼24) when treated with AZA (p¼0.02). Such superiority was not observed in DEC cohorts (6.43mo in MK cohort vs. 6.67mo in NMK cohort, p¼0.262). OS was higher in AZA-NMK vs. DEC-NMK cohort (13.63mo vs. 6.67mo, p¼0.01). Conclusions: Overall survival in AML patients (age 70) is not impacted by the choice of HMAs. However, we identified a subgroup of PRC cohort harboring NMK where OS was significantly greater when treated with AZA compared to DEC. Thus we recommend AZA to be considered as frontline option for elderly AML patients with PRC where benefit is derived specifically in patients harboring NMK. AML-221 Acute Leukemia Induction Related Mortality: 6-Y Experience of Saudi Tertiary Care Institute Amal Alabdulwahab  , Hussein Elsayed, Mohamed Sherisher, Khaleeq Unnisa, Ahmed Zeeneldin King Abdulla Medical City-HC, Makkah, Saudi Arabia Context: Mortality during induction therapy for acute leukemia, is a multifactorial process resulting in early treatment failure. It had shown sharp decline in the past 20 years in the Western world compared with developing countries. Objective: To determine the incidence, etiology, risk factors for mortality in acute leukemia patients who received intensive induction using conventional chemotherapy protocols. Design: A retrospective analysis of patients who were referred to KAMC-HC during the period from Mid-2011 to the first quarter of 2017 for acute leukemia treatment. Setting: The study was carried in KAMC-HC which is a relatively new tertiary care facility in the Western province of Saudi Arabia. Patients or Other Participants: 197 Patients out of 227 with acute leukemia (107 AML, 90 ALL & MPAL) who were eligible for intensive chmotherapy were included in Table 1 Baseline Characteristics and Treatment Responses in the Entire Cohort Decitabine (n[89) n (%) Azacitidine (n[163) Gender Male 57 (64.0%) 103 (63.2%) Female 32 (36.0%) 60 (36.8%) Median Age 77 76 Type of AML De novo AML 39 (43.8%) 82 (50.3%) Secondary AML 50 (56.2%) 81 (49.7%) Cytogenetic Category Favorable-Risk Cytogenetics 0 (0%) 3 (1.8%) Intermediate-Risk Cytogenetics 51 (57.3%) 92 (56.4%) Poor-Risk Cytogenetics 29 (32.5%) 56 (34.4%) WBC <10 66 (74.2%) 130 (79.8%) >10 19 (21.3%) 24 (14.7%) Median Platelets 54,000 73,000 Median Hemoglobin level (g/dL) 9.5 9.5 FLT3-ITD Status (Tested) 44 69 Positive 5 (11.4%) 5 (7.2%) Negative 39 (88.6%) 64 (92.8%) NPM1 Status (Tested) 41 71 Positive 5 (12.2%) 4 (5.6%) Negative 36 (87.8%) 67 (94.4%) Overall Responses CR+CRi 21 (23.6%) 35 (21.5%) PR 11 (12.4%) 20 (12.3%) SD/TF 43 (48.3%) 83 (50.9%) Abstracts Clinical Lymphoma, Myeloma & Leukemia September 2017 - S295