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“How I treat” older, unfit patients with AML using Aza + Ven: A case series
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A ‘how I treat’ case series published in Blood by Wei et al.1 discussed the safe and effective use of Aza + Ven in older, unfit patients with AML in routine clinical practice.
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| Key learnings |
| Case 1: 75-year-old male with NPM1mut AML. As FLT3-ITD, RAS, or TP53 mutations were absent, Aza + Ven was selected as initiation (to minimize the risk of TLS), remission induction, and post-remission therapy. |
| Case 2: 76-year-old male with FLT3-ITDmut AML, unfit for IC, ECOG score of 2, and comorbidities. Aza + Ven induction regimen with each cycle spaced 6 weeks apart was given. In C4, Ven exposure was reduced to 14 days, with plans to further shorten both therapies to reduce hematopoietic toxicity during remission. |
| Case 3: 69-year-old male with TP53mut AML and a history of DBCL. Two cycles of Aza + Ven resulted in myeloblasts <5%, normalized karyotype, and partially recovered blood counts. |
| Case 4: 67-year-old female with NPM1mut, DNMT3Amut, and TET2mut AML. Patient achieved CR after IC and consolidation and was NPM1mut MRD-negative at the end of chemotherapy; however, relapsed prior to allo-HSCT. Aza + Ven were chosen as a salvage therapy due to lower toxicity compared with IC. After achieving remission on D21 and completing 3 cycles of Aza + Ven, the patient proceeded to allo-HSCT. |
| These case series highlight key challenges in clinical practice and offer directions for safe and effective use of Aza + Ven. |
Abbreviations: Allo-HSCT, allogeneic hematopoietic stem cell transplant; AML, acute myeloid leukemia; Aza, azacitidine; C, cycle; CR, complete remission; D, day; DBCL, diffuse large B-cell lymphoma; IC, intensive chemotherapy; m, mutation; MRD, measurable residual disease; TLS, tumor lysis syndrome; Ven, venetoclax.
- Wei AH, Loo S, Daver NG. How I Treat patients with AML using azacitidine and venetoclax. Blood. 2024. Online ahead of print. DOI: 1182/blood.2024024009
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