Kuo-Kai Chin ∗ , Yannis Valtis ∗ , Andriy Derkach , Meira Yisraeli Salman , Leora Boussi , Jenna Ciervo , Mark B. Geyer , Jae H. Park , Martin S. Tallman , Jacob L. Glass , Aaron D. Goldberg , Eytan M. Stein
{"title":"Intensive chemotherapy after hypomethylating agent and venetoclax in adult acute myeloid leukemia","authors":"Kuo-Kai Chin ∗ , Yannis Valtis ∗ , Andriy Derkach , Meira Yisraeli Salman , Leora Boussi , Jenna Ciervo , Mark B. Geyer , Jae H. Park , Martin S. Tallman , Jacob L. Glass , Aaron D. Goldberg , Eytan M. Stein","doi":"10.1016/j.bneo.2024.100038","DOIUrl":null,"url":null,"abstract":"<div><h3>Abstract</h3><div>The combination of a hypomethylating agent (HMA) and venetoclax (VEN) is approved for adults aged >75 years with newly diagnosed acute myeloid leukemia (AML) as well as those ineligible for intensive chemotherapy (IC). HMA/VEN is increasingly substituted for IC in adults with AML aged <75 years, particularly in those with adverse cytogenetic and molecular features. When patients fail to respond or relapse after HMA/VEN, the utility of salvage IC is largely unknown. We performed a retrospective single-institution study and identified 46 patients who received IC after HMA/VEN, including 24 patients who received HMA/VEN as their first treatment for AML. This population had complete remission (CR)/CR with incomplete count recovery (CRi)/morphologic leukemia-free state rate of 37%, CR/CRi rate of 28%, and a median overall survival (mOS) of 7.2 months (95% confidence interval, 5.0-10.3). Patients who relapsed after an initial response to HMA/VEN and subsequently received IC were more likely to achieve a CR/CRi than those refractory to HMA/VEN (50% vs 19%; <em>P</em> = .04), although there was no statistically significant difference in survival (mOS, 8.8 vs 5.4 months; <em>P</em> = .64). Age >65 years predicted poorer survival (mOS, 4.3 vs 10.6 months; <em>P</em> < .001). IC after HMA/VEN should be further studied and chosen with caution.</div></div>","PeriodicalId":100189,"journal":{"name":"Blood Neoplasia","volume":"1 4","pages":"Article 100038"},"PeriodicalIF":0.0000,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Blood Neoplasia","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2950328024000384","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
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Abstract
The combination of a hypomethylating agent (HMA) and venetoclax (VEN) is approved for adults aged >75 years with newly diagnosed acute myeloid leukemia (AML) as well as those ineligible for intensive chemotherapy (IC). HMA/VEN is increasingly substituted for IC in adults with AML aged <75 years, particularly in those with adverse cytogenetic and molecular features. When patients fail to respond or relapse after HMA/VEN, the utility of salvage IC is largely unknown. We performed a retrospective single-institution study and identified 46 patients who received IC after HMA/VEN, including 24 patients who received HMA/VEN as their first treatment for AML. This population had complete remission (CR)/CR with incomplete count recovery (CRi)/morphologic leukemia-free state rate of 37%, CR/CRi rate of 28%, and a median overall survival (mOS) of 7.2 months (95% confidence interval, 5.0-10.3). Patients who relapsed after an initial response to HMA/VEN and subsequently received IC were more likely to achieve a CR/CRi than those refractory to HMA/VEN (50% vs 19%; P = .04), although there was no statistically significant difference in survival (mOS, 8.8 vs 5.4 months; P = .64). Age >65 years predicted poorer survival (mOS, 4.3 vs 10.6 months; P < .001). IC after HMA/VEN should be further studied and chosen with caution.
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