Azacitidine in Combination with Venetoclax Maintenance Post-allogeneic Hematopoietic Stem Cell Transplantation in T Cell Acute Lymphoblastic Leukemia

Intensified conditioning regimens with total marrow irradiation/etoposide/cyclophosphamide and busulfan/etoposide/cyclophosphamide overcome the impact of pre‐transplant minimal residual disease on outcomes in high‐risk acute lymphoblastic leukemia patients in complete remission

“…Nevertheless, one study showed that four patients with high‐risk T‐ALL who received 5‐azacitidine and venetoclax as maintenance therapy after transplantation achieved sustained complete remission, and tolerated this treatment for a median follow‐up period of 15 months. 38 These studies will pave the way for the maintenance treatment of patients after transplantation. In addition to maintenance therapy, the donor source, and GVHD prophylaxis are also important for the outcomes of ALL patients who underwent transplantation.…”

“…However, data on post‐transplantation maintenance therapy is relatively scarce for T‐ALL compared with B‐ALL. Nevertheless, one study showed that four patients with high‐risk T‐ALL who received 5‐azacitidine and venetoclax as maintenance therapy after transplantation achieved sustained complete remission, and tolerated this treatment for a median follow‐up period of 15 months 38 . These studies will pave the way for the maintenance treatment of patients after transplantation.…”

DNA methylation in T cell leukaemia

“…Even transplantation of allogeneic haematopoietic stem cells has been considered for relapsed T-ALL [176]. Interestingly, there have been several case reports of successful treatment of relapse T-ALL with the DNMT inhibitors 5-azacytidine or decitabine in combination with the BCL2 inhibitor Venetoclax [203][204][205]. Further promising treatments are currently in clinical trials [192] and include the JAK-STAT inhibitor ruxolitinib [192] and CAR T cell therapy [198].…”

Novel strategies to prevent and overcome relapse after allogeneic hematopoietic cell transplantation in acute lymphoblastic leukemia

“…In the clinical setting, robust data is scarce regarding post-transplant maintenance in patients diagnosed with T-ALL. Four cases with high-risk T-ALL were treated with maintenance 5azacitidine and venetoclax in the post-transplant setting with encouraging results, as all of them remained in CR after a median follow-up of 15 months (65). A Chinese study evaluated the use of low dose decitabine as maintenance post-transplant in ALL, with impressive results in patients with T-ALL, as none of seven treated patients have relapsed (66).…”