Case Report

Age-Adjusted Schedules of Venetoclax and Hypomethylating Agents to Treat Extremely Elderly Patients with Acute Myeloid Leukemia

Table 1

Clinical trial outcomes in AML patients using venetoclax plus hypomethylating agents.

StudyPhase of studyPatient populationNumber of patientsTreatment and dosing usedMedian age, years (range)# patients >75 years oldResponse rate (CR + CRi)CRMedian event-free survivalMedian duration of CR + CRiMedian overall survivalGrade 3/4 adverse events

Dinardo et al., Lancet Oncol, 2018 [2]1bAge >65, treatment naïve, ineligible for standard induction573 + 3 dose escalation; venetoclax-group A: target doses 400, 800, and 1200 mg/m2; group B: target doses 400, 800, and 1200 mg/m2; group C: target dose 400 mg/m2; azacitidine-75 mg/m2; decitabine-20 mg/m2Group A: 74 (71.5–79.0); group B: 75 (71.0–80.0); group C: 74 (69.0–79.5)3961.4% (35/57)24.6% (14/57)Not reportedGroup A: 8.4 mos; group B: 12.3 mos; group C: 4.3 mos12.3 months (all groups)Thrombocytopenia; febrile neutropenia; neutropenia
Dinardo et al., Blood, 2019 [3]1bAge >65, treatment naïve, ineligible for standard induction145Venetoclax-ramp-up C1 from 20 (escalation phase) or 100 (expansion); target doses: 400, 800, and 1200 mg/m2; in escalation expansion phase: 400 mg and 800 mg; azacitidine-42 mg/m2, d1-7; decitabine-20 mg/m2, d1-574 (65–86)5267%37%Not reported11.3 months17.5 monthsFebrile neutropenia; anemia; thrombocytopenia; neutropenia; pneumonia
Dinardo et al., NEJM, 2020 [1]3Ineligible for intensive induction, age >75, all treatment naive286 in variable groupAza 75 mg/m2, d1-7; VEN 400 mg daily, d1-28 w/3 day ramp-up C176 (49–91)Not reported66.4%36.7%9.8 months17.5 months14.7 monthsThrombocytopenia neutropenia; febrile neutropenia; anemia; leukopenia
Maiti et al., Blood, 2018 [4]IIAge >69, ineligible for OR relapse/refractory AML48VEN days 1–28, cycle 1, D1-21; C2 and onwards VEN 200 mg PO daily in pts needing cyp3a4 decitabine-20 mg/m2 IV daily D1–D10 until CR, followed by 5-day cycles71 (22–82)Not reported71% (34/48)CR alone not reportedNot reachedNot reachedNot reachedInfections; neutropenia; tumor lysis syndrome
Wei et al., Journal of Clinical Oncology, 2019 [5]Ib/IIAge >60, treatment naïve, ineligible for intensive chemo82Venetoclax-initial 50 or 100 mg, titrated up to the target dose; phase II recommended dose: 600 mg; 800 mg in phase Ib w/prolonged myelosuppression; low-dose cytarabine-20 mg/m2 daily SC injection D1–10, 28-day cycles74 (63–90)4054%26%Not reported8.1 months10.1 monthsCytopenia, febrile neutropenia; infections
Wei et al., Blood, 2020 [6]3Adults ≥18 y/o w/ND AML ineligible for intensive chemo (38% had secondary AML, and 20% had received prior hypomethylating agent treatment)210Venetoclax + LDAC76 (33–93)8248%27%4.7 monthsNot reported7.2 monthsFebrile neutropenia; neutropenia; thrombocytopenia