Venetoclax plus a hypomethylating agent versus cytarabine, aclarubicin, and granulocyte colony‐stimulating factor chemotherapy as a first‐line therapy for newly diagnosed acute myeloid leukemia: A propensity score–matched analysis

Abstract

BackgroundBoth venetoclax plus a hypomethylating agent (VEN/HMA) and cytarabine, aclarubicin, and granulocyte colony‐stimulating factor (CAG) are low‐intensity regimens for older patients with acute myeloid leukemia (AML) that show good efficacy and safety. It is unknown how VEN/HMA compares with the CAG regimen for the treatment of newly diagnosed AML.MethodsThe outcomes of patients with newly diagnosed AML treated with VEN/HMA were compared with those of patients treated with a CAG‐based regimen. Propensity score matching between these two cohorts at a 1:1 ratio was performed according to age at diagnosis, sex, Eastern Cooperative Oncology Group performance status, state of fitness, and European LeukemiaNet (ELN) 2022 risk stratification to minimize bias.ResultsA total of 84 of 96 patients in the VEN/HMA cohort were matched with 84 of 147 patients in the CAG cohort. VEN/HMA resulted in a better response than the CAG‐based regimens, as indicated by a higher composite complete remission (CRc) rate (82.1% vs. 60.7%; p = .002) and minimal residual disease negativity rate (88.2% vs. 68.2%; p = .009). In patients with an ELN adverse risk, VEN/HMA was associated with a higher CRc rate compared to CAG (80.5% vs. 58.3%; p = .006). VEN/HMA was associated with longer event‐free survival (EFS) (median EFS, not reached vs. 4.5 months; p = .0004), whereas overall survival (OS) was comparable between the two cohorts (median OS, not reached vs. 18 months; p = .078).ConclusionsThe VEN/HMA regimen may result in a better response than CAG‐based treatment in older patients with newly diagnosed AML.