Venetoclax-Based Treatment Effective to Bridge R/R AML to Transplant

The use of venetoclax-containing therapy effectively bridged patients with relapsed or refractory acute myeloid leukemia (AML) to allogeneic hematopoietic stem cell transplantation (HSCT), according to results of an abstract from the 2022 ASH Annual Meeting and Exposition.

Julia M. Unglaub, MD, of University Hospital Heidelberg in Germany, and colleagues included patients with relapsed (32%) or refractory (68%) disease after initial intensive induction therapy. Between October 2018 and April 2021, 37 patients started venetoclax-based salvage treatment as a bridging strategy. About half (46%) of patients had adverse-risk disease, 27% had favorable-risk, and 27% had intermediate-risk classification.

Thirty-six patients had venetoclax plus standard-dose azacitidine and one had venetoclax plus low-dose cytarabine.

The overall response rate was 89%, with 57% achieving complete response (CR) /CRi. Both 30-day and 60-day mortality was 3%.

The majority of patients (70%) were able to go on to allogeneic HSCT. At the time of the analysis, the majority were alive (65%) and still in CR (62%).

Dr. Unglaub and colleagues then used propensity score matching to compare these patients with patients from a registry who received non-venetoclax-based salvage treatment. In the abstract, Dr. Unglaub and colleagues pointed out that this group had significantly more patients with intermediate risk (56% vs 27%; P=.005), but less with adverse risk (22% vs 46%; P=.009). Similar to the venetoclax-based group, allogeneic HSCT was performed in 67% of these patients.

Median follow-up was about 1.5 years for the venetoclax-treated group and more than five years for the non-venetoclax group. The median event-free survival for venetoclax-treated patients was 8.02 months compared with 4.53 months for non-venetoclax treated patients. The median relapse-free survival was 7.16 months for venetoclax compared with 9.66 months for non-venetoclax treated patients.

Median overall survival was almost six-months longer with venetoclax-based treatment (15.08 vs 9.66 months (95% CI, 4.99-19.5).

Propensity score matching showed a non-significant benefit for treatment with venetoclax with a hazard ratio of 0.65 (95% CI, 0.36-1.17).

Reference

Unglaub JM, Schlenk RF, Hanoun M, et al. Venetoclax-based salvage therapy improves outcome in relapsed/refractory AML patients eligible for intensive treatment: a propensity score matching analysis. Abstract #1438. Presented at the 64th ASH Annual Meeting and Exposition; December 10-13, 2022; New Orleans, Louisiana.