How do I manage the myelotoxicity of venetoclax and azacitidine in patients with newly diagnosed acute myeloid leukemia?

Abstract

The introduction of venetoclax in combination with azacitidine (venAZA) represents a turning point in the treatment of patients with newly diagnosed acute myeloid leukemia (AML) who are ineligible for intensive chemotherapy due to age, performance status and/or significant comorbidities. Conducting venAZA treatment in routine clinical practice, however, can present significant difficulties, due to both the substantial myelotoxicity (severe hematological side effects during venAZA are experienced by the majority of patients) and the clinical characteristics of AML patients not eligible for intensive chemotherapy. Thus, for optimal treatment outcomes, appropriate patient qualification for treatment and robust management of venAZA hematological toxicity are crucial. Retrospective data indicate that modification of venetoclax and azacitidine dosing during treatment is associated with longer treatment duration and translates favourably into longer overall survival. Here, the authors outline the management of patients with newly diagnosed AML in whom treatment with venAZA is complicated by profound myelosuppression.