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  • Kadia, Tapan M; Reville, Patrick K; Wang, Xuemei; Rausch, Caitlin R; Borthakur, Gautam; Pemmaraju, Naveen; Daver, Naval G; DiNardo, Courtney D; Sasaki, Koji; Issa, Ghayas C; Ohanian, Maro; Montalban-Bravo, Guillermo; Short, Nicholas J; Jain, Nitin; Ferrajoli, Alessandra; Bhalla, Kapil N; Jabbour, Elias; Takahashi, Koichi; Malla, Rashmi; Quagliato, Kelly; Kanagal-Shamanna, Rashmi; Popat, Uday R; Andreeff, Michael; Garcia-Manero, Guillermo; Konopleva, Marina Y; Ravandi, Farhad; Kantarjian, Hagop M

    Journal of clinical oncology, 11/2022, Letnik: 40, Številka: 33
    Journal Article

    The combination of venetoclax and 5-azacitidine (5-AZA) for older or unfit patients with acute myeloid leukemia (AML) improves remission rates and survival compared with 5-AZA alone. We hypothesized that the addition of venetoclax to cladribine (CLAD)/low-dose araC (low-dose cytarabine LDAC) alternating with 5-AZA backbone may further improve outcomes for older patients with newly diagnosed AML. This is a phase II study investigating the combination of venetoclax and CLAD/LDAC alternating with venetoclax and 5-AZA in older (≥ 60 years) or unfit patients with newly diagnosed AML. The primary objective was composite complete response (CR) rate (CR plus CR with incomplete blood count recovery); secondary end points were overall survival, disease-free survival (DFS), overall response rate, and toxicity. A total of 60 patients were treated; median age was 68 years (range, 57-84 years). By European LeukemiaNet, 23%, 33%, and 43% were favorable, intermediate, and adverse risk, respectively. Fifty-six of 60 evaluable patients responded (composite CR: 93%) and 84% were negative for measurable residual disease. There was one death (2%) within 4 weeks. With a median follow-up of 22.1 months, the median overall survival and DFS have not yet been reached. The most frequent grade 3/4 nonhematologic adverse events were febrile neutropenia (n = 33) and pneumonia (n = 14). One patient developed grade 4 tumor lysis syndrome. Venetoclax and CLAD/LDAC alternating with venetoclax and 5-AZA is an effective regimen among older or unfit patients with newly diagnosed AML. The rates of overall survival and DFS are encouraging. Further study of this non-anthracycline-containing backbone in younger patients, unfit for intensive chemotherapy, as well as comparisons to standard frontline therapies is warranted.