Venetoclax plus cyclophosphamide and cytarabine as induction regimen for adult acute myeloid leukemia

Baohang Zhang; Qingguo Liu; Junfan Li; Yimin Hu; Xin Zhao; Pingping Huang; Shangzhu Li; Ying Wang

doi:10.3389/fonc.2023.1193874

Venetoclax plus cyclophosphamide and cytarabine as induction regimen for adult acute myeloid leukemia

Front Oncol. 2023 May 19:13:1193874. doi: 10.3389/fonc.2023.1193874. eCollection 2023.

Authors

Baohang Zhang^{1

2}, Qingguo Liu^{1

2}, Junfan Li^{1

2}, Yimin Hu^{1

2}, Xin Zhao^{1

2}, Pingping Huang^{1

2}, Shangzhu Li^{1

2}, Ying Wang^{1

2}

Affiliations

¹ National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China.
² Tianjin Institutes of Health Science, Tianjin, China.

Abstract

Background: The efficacy of induction chemotherapy (IC) for acute myeloid leukemia (AML) has improved significantly with the application of targeting drugs. Our previous study showed that a 4-day IC regimen of cyclophosphamide (CTX) and Ara-C [CA (4 + 3)] achieved similar complete remission (CR) rate (80%) compared with the traditional 7-day regimen, and the survival rate appeared to be better.

Methods: In this pilot study, we further shortened the CA regimen to 3 days, added low-dose venetoclax (VEN, 200 mg/day) (VCA), and reported the efficacy and safety here.

Results: Twenty-five newly diagnosed adult AML patients were enrolled in this study and evaluated for the remission rate after one cycle of the VCA regimen. The CR/Cri was 92%, and all these patients had undetectable minimal residual disease (MRD^-). The estimated overall survival at 12 months was 79.3%. The median time for both platelet recovery and absolute neutrophil count recovery was 16 days, faster than that of traditional IC. Compared with the previous CA (4 + 3) regimen, a higher CR rate (92% vs. 80%, P < 0.01) and a deeper degree of remission (CR_MRD- rate, 92% vs. 45%, P < 0.01) were found in the VCA group.

Conclusions: This study showed that the 3-day CTX and Ara-C regimen is highly effective in newly diagnosed AML patients, and the addition of VEN to the CA regimen achieves higher and deeper one-course remission.

Keywords: acute myeloid leukemia; cyclophosphamide; cytarabine; induction chemotherapy; venetoclax.

Grants and funding

This study was supported by the National Natural Science Foundation of China (grant no. 81900127).