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

Table 2

Clinical characteristics of three extremely elderly AML patients treated with venetoclax and azacitidine.

Age at diagnosis

Medical comorbidities

Blood count at bone marrow diagnosis

Cytogenetics

Next-generation sequencing

Blast (%) in the marrow at diagnosis

Bridging therapy used prior to venetoclax plus HMA

Hospitalized for induction?

Complications from induction

Response to induction

Fungal prophylaxis during induction

Progression-free survival

Postinduction complications

1

87

Melanoma (in situ, resected); hyperlipidemia; hypertension

WBC: 84,900; Hgb: 9.3; platelet: 81; ANC: 5943

Karyotype: normal; FISH: normal

SF3B1 K666 N (VAF 47%), FLT3 D835Y (VAF 45%), and RUNX1 D93Afs ∗ 31 (VAF 42%)

95

Hydroxyurea

Yes

Neutropenic fever; atrial fibrillation with rapid ventricular response; upper extremity phlebitis

CR

Micafungin

13 months, relapse following cycle 11

Sweet’s syndrome following C11

2

92

Lung adenocarcinoma; prostate cancer (localized); hypertension

WBC: 0.4; Hgb: 8.6; platelet: 72; ANC: 136

Abnormal karyotype; deletion 6q; FISH: loss of 6q (33%) and 7q (29%)

Mutations in DNMT3A, SRSF2, RUNX1, BCOR, TET2, and BCR-ABL neg

43

None

Yes

None

CR

Micafungin

13 months

Neutropenic fever following C10; COVID-19 pneumonia

3

85

Prostate cancer (localized); minimal change disease; hypertension; hyperlipidemia

WBC: 38.3; Hgb: 7.6; platelet: 25; ANC: 5745

Karyotype: abnormal; deletion 20q; gain of X chromosome in two clones; FISH: diminished D20S108 (20q12) hybridization in 65% of cells

Mutations in RUNX1, SMC3, and TET2

80

Hydroxyurea

Yes

Tumor lysis syndrome

Partial response

Posaconazole

4 months on therapy, progression during cycle 4

GI bleeding and bacteremia following C5

Patient 1: C1 venetoclax 400mg 3 day ramp up to D21 + azacitidine 75 mg/m² D1-7. C2 venetoclax 400mg D1-21, azacitidine 75 mg/m2 D1-7. C3 venetoclax 400mg D1-14, azacitidine 75 mg/m² D1-7. C4-C5 azacitidine 75 mg/m² D1-7, venetoclax held due to cytopenia. C6-C11 Ven 400mg D1-14, azacitidine 75 mg/m2 D1-7. C12-17 azacitidine only. Gilteritinib thereafterPatient 2: C1 venetoclax 400mg (no escalation) D1-21, azacitidine 75 mg/m² d1-7. C2-3 venetoclax 400 D1-14 (avoid cytopenia), azacitidine 75 mg/m² D1-7. C4-5 azacitidine only secondary to cytopenias. C6-7 venetoclax 1-14d, with azacitidine. C8-10 azacitidine only. Patient 3: C1-3 venetoclax 100mg daily 1-21, Decitabine 20 mg/m² d1-5. C4 Decitabine 20 mg/m² d1-5. C5 venetoclax 100 mg daily, Decitabine 20 mg/m² d1-5.