Phase II Trial of Venetoclax (Ven) in Combination with Azacitidine (AZA) As Maintenance Therapy for High-Risk Acute Leukemia Following Allogeneic Stem Cell Transplantation (SCT)

Oran, Betül; Champlin, Richard E.; Thall, Peter F.; McCarty, Jessica M; Zhang, Wen; Marin, David; Mehta, Rohtesh S.; Alousi, Amin M.; Alatrash, Gheath; Popat, Uday; Kantarjian, Hagop; Bashir, Qaiser; Shpall, Elizabeth J.; Konopleva, Marina

doi:10.1182/blood-2022-159312

Cited by 2 publications

(1 citation statement)

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“…Separate data for the AML cohort were not reported. 75 Cytopenia was significant with 30% of patients requiring venetoclax dose modifications; however, there was only one graft failure. In another study from China in patients with high-risk MDS/AML, low-dose decitabine (15 mg/m 2 for 3 days) and venetoclax (200 mg for 21 days) repeated every 2 months for ten cycles from day +100 after HSCT resulted in a 2-year EFS and OS of 85%.…”

Section: Non-allogeneic Stem Cell Transplanted-directed Maintenancementioning

confidence: 99%

Maintenance therapy in acute myeloid leukemia: advances and controversies

2023

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The last decade has seen a steadfast progression in drug development in acute myeloid leukemia (AML) which have moved progressively towards genomics-based therapy. With these advancements, outcomes in AML have improved but remains far from satisfactory. An approach towards preventing relapse in AML is the use of a maintenance therapy in patients, after attaining remission. Allogeneic hematopoietic stem cell transplantation (HSCT) is an effective post-remission therapy that has been proven to reduce the risk of relapse. However, in patients who are ineligible for HSCT or have a high risk of relapse, other effective measures to prevent relapse are needed. There also exists a need for post HSCT maintenance to reduce relapse in high-risk subsets. Over the last 3 decades maintenance therapy in AML has evolved from the use of chemotherapeutic agents to more targeted therapies and better modulation of the immune system. Unfortunately, improvement in survival outcomes from these agents have not been consistently demonstrated in clinical trials. To derive the optimum benefit from maintenance therapy the time points of therapy initiation need to be defined and therapy selection must be precise with respect to the AML genetics and risk stratification, prior treatment exposure, transplant eligibility, expected toxicity and patient’s clinical profile and desires. The far-reaching goal is to facilitate patients with AML in remission to achieve a normal quality of life while improving remission duration and overall survival. The QUAZAR trial was a welcome step towards a safe maintenance drug with ease of administration and showed survival benefit but leaves many open issues for discussion. In this review we will discuss these issues, highlighting the development of AML maintenance therapies over the last 3 decades.

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Section: Non-allogeneic Stem Cell Transplanted-directed Maintenancementioning

confidence: 99%