A recent multicentre retrospective analysis has provided critical insights into the use of Venetoclax (VEN) combined with a hypomethylating agent (HMA) in treating acute myeloid leukeamia (AML) in patients aged 80 years and older. While this regimen is the standard care for older adults with AML, its application in very elderly patients has been challenging due to significant myelosuppression and related complications.
The study reviewed 154 patients aged 80–92 who received VEN-HMA treatment between March 2015 and April 2022. Physicians adjusted VEN dosing based on CYP3A4 drug interaction considerations. The majority of patients (53%) had adverse risk AML, with a median follow-up of 7.7 months.
Despite the high-risk group, 36 patients (23%) remained in remission, and 31 (20%) continued treatment. Notably, the composite complete remission rate for newly diagnosed AML patients was 73%, with a median overall survival (OS) of 8.1 months, extending to 13.2 months in those who achieved a response.
Patients receiving VEN for 14 days or less showed a significantly improved median OS of 24.0 months. The findings suggest that while VEN-HMA is effective and feasible for very elderly patients with AML, careful dose adjustments and cycle extensions are crucial for ensuring long-term tolerability. The study underscores the potential for safely managing AML in octogenarians and nonagenarians, offering hope for extended survival with appropriate treatment modifications.
Helena Bradbury, EMJ
Reference
Madarang E et al. Venetoclax and Hypomethylating Agents in Octo- and Nonagenarians with Acute Myeloid Leukemia. Blood Neoplasia. 2024;1(2):100016.
