Acute myeloid leukemia (AML) mainly affects older adults, and is associated with few treatment options and poor outcomes. 1 The VIALE-A trial (NCT02993523) investigated venetoclax (Ven), a potent B-cell lymphoma 2 (BCL-2) inhibitor, plus azacitidine (Aza) in patients with AML who were ineligible for intensive chemotherapy. 2 The Ven + Aza combination demonstrated a median overall survival (OS) of 14.7 months compared with 9.6 months in the placebo (Pbo) + Aza arm (hazard ratio = 0.66; 95% confidence interval [CI]: 0.52-0.85, p < .001). 2 Neutropenia and related infections are common in patients with AML, and antimicrobial prophylaxis for patients with AML is supported by data from randomized studies that investigated the use of levofloxacin and posaconazole in patients with neutropenia receiving high-intensity chemotherapy. 3,4 The use of moderate or strong cytochrome P450 3A inhibitors (CYP3Ai) such as triazole antifungals, has been shown to increase Ven (a CYP3A substrate) exposure by reducing clearance, necessitating Ven dose reductions when concomitantly administered. 5,6 Thus, Ven dose modifications were required in VIALE-A for the concomitant use of CYP3Ai. 2 The purpose of this post hoc analysis of the VIALE-A trial was to evaluate patient outcomes in the setting of Ven dose modifications due to concomitant use of CYP3Ai.The randomized, double-blind, placebo-controlled phase 3 VIALE-A trial evaluated the efficacy and safety of Ven + Aza compared with Pbo + Aza in patients with AML who were aged ≥75 years or ineligible for intensive chemotherapy. This post hoc analysis describes the OS, response rates, and rates of fungal infections in the setting of early CYP3Ai use when initiating Ven + Aza. The full VIALE-A trial excluded patients with evidence of clinically significant uncontrolled systemic infection requiring therapy; the study design, statistical analysis, and results were previously reported. 2 A summary of the study design and Ven dosing modifications for neutropenia can be found in the Supplement. In this analysis, early use of anti-infective CYP3Ai is defined as medications initiated during Cycle 1 or 2 of Ven + Aza administration. Patients in VIALE-A were divided into three groups according to their early use of CYP3Ai: no use of CYP3Ai (none), use of any moderate CYP3Ai (moderate), and use of any strong CYP3Ai (strong); moderate and strong CYP3Ai are listed in the Supplemental text. Seven patients in the Ven + Aza arm, and one patient