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Venetoclax-based therapies in ND non-CBF therapy-related AML
Results from a retrospective, single-center analysis, evaluating venetoclax (Ven)-based therapies in adults with newly diagnosed (ND) non-core binding factor (CBF) therapy-related acute myeloid leukemia (T‑AML; N = 317), were published in HemaSphere by Senapati et al. The analysis focused particularly on outcomes with lower-intensity therapy (LIT) Ven-containing regimens (LIT + Ven; n = 122).
Key data: Composite complete response (CRc) rates were higher with LIT + Ven vs LIT alone (58% vs 40%; p = 0.003), but were similar with intensive chemotherapy (IC) + Ven vs IC alone (68% vs 61%, respectively; p = 0.59). Allogeneic hematopoietic stem cell transplantation (allo-HSCT) rate was also higher with LIT + Ven than with LIT alone (22% vs 7%; p = 0.001). With a median follow-up of 46.4 months, median overall survival (OS) and relapse-free survival (RFS) were longer with LIT + Ven vs LIT alone (OS, 9.0 months vs 5.7 months; p < 0.01; RFS, 8.0 months vs 4.4 months; p = 0.03). Within the LIT + Ven subgroup, median OS differed by European LeukemiaNet (ELN) 2024 risk (25.4, 9.4, and 4.8 months in favorable-, intermediate-, and adverse-risk disease, respectively; p = 0.001). On multivariate analysis in LIT + Ven-treated patients, allo-HSCT and NPM1/IDH2 mutations remained favorable, while RAS/TP53 mutations were associated with inferior OS.
Key learning: LIT + Ven improved response rates, survival, and allo-HSCT eligibility vs LIT alone in patients with ND non-CBF T-AML, with outcomes shaped by genomic risk and the ability to proceed to allo-HSCT.
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