Neutropenia occurrence and duration during azacitidine + venetoclax induction in ND AML

Results from a retrospective, multicenter analysis of the occurrence and duration of Grade 4 neutropenia during the first cycle of azacitidine (Aza) + venetoclax (Ven) induction therapy in adults with newly diagnosed (ND) acute myeloid leukemia (AML) were published in Blood Advances by Higué et al.

Key data: K-means clustering identified two patient populations based on the duration of Grade 4 neutropenia during Cycle 1, with a cutoff of 19 days: a short-duration group (N-Short; n = 65; median duration, 7 days) and a long-duration group (N-Long; n = 87; median duration, 31 days). Febrile neutropenia occurred in 14% of patients in the N-Short group vs 62% of those in the N-Long group (p < 0.001), while documented bacterial infection occurred in 9% vs 32%, respectively (p < 0.001). Baseline Grade 4 neutropenia, present in 2% of the N-Short group vs 46% of the N-Long group (odds ratio [OR], 54.5; 95% confidence interval [CI], 11.2–983.3; p < 0.001), was the only independent predictor of N-Long status in multivariable analysis.

Key learning: In this analysis, the duration of Grade 4 neutropenia during Cycle 1 of Aza + Ven was heterogeneous in patients with ND AML, with prolonged neutropenia associated with a higher risk of febrile neutropenia and bacterial infection. Baseline Grade 4 neutropenia was associated with prolonged Cycle 1 neutropenia, suggesting its potential utility in identifying patients who may benefit from enhanced monitoring and supportive care, although prospective evaluation is needed.