Venetoclax received full approval in October 2020 for use in older, unfit patients with acute myeloid leukemia (AML) combined with either hypomethylating agents or low-dose cytarabine. This ended a semi-centennial of stalled clinical progress and initiated a new treatment option with proven capacity to enhance response and prolong survival in older patients with AML. Despite widespread use of azacitidine-venetoclax (AZA-VEN), there is increasing appreciation that this regimen is myelosuppressive and associated with a higher risk of infectious complications than AZA alone. Key principles of initial management include prevention of tumor lysis syndrome in patients at high risk and minimizing infectious complications during induction. In the post-remission phase, limiting cumulative marrow suppression by allowing sufficient time between cycles for optimal marrow recovery and truncating the duration of venetoclax exposure for those with delayed blood count recovery have emerged as important axioms of effective care. This new addition to the How I Treat series casts a clinical spotlight on important challenges and dilemmas encountered in practice. We also outline a structured framework to assist in the safe management of AZA-VEN in the clinic.
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Review Article|
September 24, 2024
How I Treat patients with AML using azacitidine and venetoclax
Andrew H. Wei,
Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
* Corresponding Author; email: [email protected]
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Sun Loo,
Sun Loo
Peter MacCallum Cancer Centre and Royal Melbourne Hospital, 3052, Australia
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Naval G Daver
Naval G Daver
University of Texas, MD Anderson Cancer Center, Houston, Texas, United States
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Blood blood.2024024009.
Article history
Submitted:
May 3, 2024
Revision Received:
August 26, 2024
Accepted:
August 30, 2024
Citation
Andrew H. Wei, Sun Loo, Naval G Daver; How I Treat patients with AML using azacitidine and venetoclax. Blood 2024; blood.2024024009. doi: https://doi.org/10.1182/blood.2024024009
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