Pre-transplant HMA + Ven vs IC in older patients with adverse-risk AML

Results from a retrospective, international cohort study, comparing hypomethylating agents (HMA) + venetoclax (Ven) to intensive chemotherapy (IC) prior to allogeneic hematopoietic stem cell transplant (allo-HSCT) in 139 patients aged 60–74 years with European LeukemiaNet (ELN) 2022 adverse-risk acute myeloid leukemia (AML), were published in Haematologica by Berton et al. Endpoints included composite complete remission (cCR) rate, overall response rate (ORR), overall survival (OS), relapse-free survival (RFS), cumulative incidence of relapse (CIR), and non-relapse mortality (NRM). 

Key data: The cCR rates were 77% and 71%, and ORRs were 91% and 77% in the HMA + Ven and IC groups, respectively. Among responders, 73% and 63% were measurable residual disease (MRD) negative in the HMA + Ven and IC groups, respectively. Post-allo‑HSCT OS (p = 0.636), RFS (p = 0.959), NRM (p = 0.632), and CIR (p = 0.643) did not significantly differ between groups. In multivariable analyses, achievement of a cCR at allo-HSCT was associated with improved survival (p = 0.001), while monosomal karyotype was associated with worse survival (p = 0.003). 

Key learning: Results suggest that HMA + Ven is a feasible pre-transplant induction alternative to IC in older patients with adverse-risk AML; longer follow-up is warranted.