Many patients over the age of 80 can safely and effectively be treated for acute myeloid leukaemia (AML) with venetoclax combined with a hypomethylating agent (VEN-HMA), according to a major new study.
US researchers studied the care of patients in the USA and Italy for the project, reported in the journal Blood Neoplasia.
Their analysis included 154 elderly patients, treated at six institutions with the standard of care for this age-group of VEN-HMA. The patients in the study were aged between 80 and 92, with a median age of 82. 69% were male, and 77% newly diagnosed with AML (i.e. non-relapsed).
67% started with the standard dose and treatment schedule of VEN-HMA, and 72% of these patients had subsequent alterations to the treatment following their first cycle of VEN-HMA.
The study found that 20 to 25% of the treated patients experienced prolonged survival - representing 40% of those who responded to treatment. Those judged to have responded to treatment experienced median overall survival of 13.2 months.
When the disease was newly diagnosed and patients had not experienced myelodysplastic syndrome beforehand, 73% achieved complete remission, even if blood cell counts did not fully recover. The project also identified groups of patients who experienced poor survival.
Researcher Dr Justin Watts, a haematologist at the University of Miami Sylvester Comprehensive Cancer Center, in Miami, Florida, said: “Our study reveals that a significant portion of these patients at the extremes of older age still derive benefit from the VEN-HMA regimen – which is the standard of care for older AML patients and those who are ineligible to receive intensive chemotherapy.
“While acknowledging it certainly isn’t for everyone, we hope our findings encourage health care providers to thoughtfully explore all treatment avenues for elderly patients with AML, rather than prematurely resorting to HMA alone, best supportive care, or hospice care.”
Dr Watts added: “A second major theme here is that treating this patient population requires adjusting the dosage and duration of VEN-HMA. Unlike typical adult AML cases, these patients exhibit lower tolerance to venetoclax, suggesting that they may benefit from a reduced dosage.”
Source:
Madarang E, Lykon J, Zhao W, Sekeres MA, Bradley T, Chandhok NS, Taylor J, Venugopal S, Koru-Sengul T, Iyer SG, Gilbert J, Miller RM, Nanni J, Zacheo I, Mattei A, Al Ali N, Kishtagari A, Marconi G, Sallman DA, Pollyea DA, Savona MR, Papayannidis C, Komrokji R, Watts J. (2024) “Venetoclax and Hypomethylating Agents in Octo- and Nonagenarians with Acute Myeloid Leukemia.” Blood Neoplasia, 7 May 2024, doi: 10.1016/j.bneo.2024.100016
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