Venetoclax and Azacitidine in Relapsed/Refractory Acute Myeloid Leukemia and High Risk Myelodysplastic Syndrome: Bursa Uludag University Experience

Year 2021, , 42 - 43, 07.03.2021

İbrahim Ethem Pınar , Fahir Özkalemkaş , Vildan Ozkocaman , Tuba Ersal Cumali Yalçın Bedrettin Orhan , Ömer Candar

https://doi.org/10.46310/tjim.877068

Abstract

The management of acute myeloid leukemia (AML) gradually turns into an individualized approach with the application of targeted therapies. Venetoclax is a BCL-2 inhibitor that is synergistic with azacitidine. In this case series, 14 patients diagnosed with relapsed / refractory AML and 1 MDS RAEB-1 were followed up with venetoclax + azacitidine in the Hematology Department Bursa Uludag University Faculty of Medicine were evaluated. The best responses obtained with venetoclax + azacitidine were complete remission (CR) in one patient, complete remission with incomplete hematologic recovery (CRi) in one patient, morphological leukemia-free state (MLFS) in 4 patients, and partial response (PR) in one patient. The median time to first response with treatment was one month (0.5-5). The time to enter early remission is critical. For this reason, deaths due to infection should be prevented. Although the toxicities of this combination therapy can be managed, close follow-up of the patients is mandatory. In conclusion, this combination therapy is promising as it is relatively well-tolerated, improves the quality of life, and prolongs survival.

Keywords

Venetoclax, azacitidine, acute myeloid leukemia, myelodysplastic syndrome

References

• 1. Almeida AM, Ramos F. Acute myeloid leukemia in the older adults. Leuk Res Rep. 2016 Jun 16;6:1-7. doi: 10.1016/j.lrr.2016.06.001.
• 2. Song X, Peng Y, Wang X, Chen Y, Jin L, Yang T, Qian M, Ni W, Tong X, Lan J. Incidence, Survival, and Risk Factors for Adults with Acute Myeloid Leukemia Not Otherwise Specified and Acute Myeloid Leukemia with Recurrent Genetic Abnormalities: Analysis of the Surveillance, Epidemiology, and End Results (SEER) Database, 2001-2013. Acta Haematol. 2018;139(2):115-127. doi: 10.1159/000486228.
• 3. Döhner H, Weisdorf DJ, Bloomfield CD. Acute Myeloid Leukemia. N Engl J Med. 2015 Sep 17;373(12):1136-52. doi: 10.1056/NEJMra1406184.
• 4. DiNardo CD, Jonas BA, Pullarkat V, Thirman MJ, Garcia JS, Wei AH, Konopleva M, Döhner H, Letai A, Fenaux P, Koller E, Havelange V, Leber B, Esteve J, Wang J, Pejsa V, Hájek R, Porkka K, Illés Á, Lavie D, Lemoli RM, Yamamoto K, Yoon SS, Jang JH, Yeh SP, Turgut M, Hong WJ, Zhou Y, Potluri J, Pratz KW. Azacitidine and Venetoclax in Previously Untreated Acute Myeloid Leukemia. N Engl J Med. 2020 Aug 13;383(7):617-629. doi: 10.1056/NEJMoa2012971.
• 5. DiNardo CD, Pratz K, Pullarkat V, Jonas BA, Arellano M, Becker PS, Frankfurt O, Konopleva M, Wei AH, Kantarjian HM, Xu T, Hong WJ, Chyla B, Potluri J, Pollyea DA, Letai A. Venetoclax combined with decitabine or azacitidine in treatment-naive, elderly patients with acute myeloid leukemia. Blood. 2019 Jan 3;133(1):7-17. doi: 10.1182/blood-2018-08-868752.