Treatment outcomes and safety of reduced‑dose venetoclax plus antifungal agents to treat acute myeloid leukemia: A single hospital experience in Taiwan
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- Published online on: March 21, 2025 https://doi.org/10.3892/ol.2025.14987
- Article Number: 241
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Copyright: © Hsiao et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
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Abstract
Venetoclax, an orally administered B‑cell lymphoma 2 inhibitor, requires dose adjustments when coadministered with cytochrome P450 inhibitors in patients with acute myeloid leukemia (AML). The present study retrospectively analyzed data on progression‑free survival (PFS), overall survival (OS) and drug‑related adverse events in patients with AML who received adjusted low‑dose venetoclax with antifungal agents, compared with those receiving conventional chemotherapy regimens (I3A7, LDAC, and I2A5) , at a single hospital. In total, 45 patients with AML who were treated between January 2015 and December 2021 were retrospectively included. A significantly longer median OS time was observed in the group receiving idarubicin [12 mg/m² intravenous (IV) on days 1‑3] and cytarabine (100 mg/m² continuous IV infusion on days 1‑7) (I3A7 group) (median not reached) compared with that in the venetoclax group [10.7 months; 95% confidence interval (CI), 6.3‑20.8], the low‑dose cytarabine (LDAC) group (4.7 months; 95% CI, 0.8‑18.7) and the group receiving idarubicin (12 mg/m² IV on days 1‑2) with cytarabine (100 mg/m² continuous IV infusion on days 1‑5) (I2A5 group) (2.3 months; 95% CI, 0.5‑2.3). Similarly, the median PFS time was significantly longer in the I3A7 group (29.0 months; 95% CI, 1.1‑29.0) compared with that in the venetoclax (8.0 months; 95% CI, 0.8‑10.8), LDAC (2.1 months; 95% CI, 0.1‑6.4) and I2A5 (0.9 months; 95% CI, 0.1‑4.7) groups. Grade 3 or higher adverse hematological events were common across all treatment groups. Cardiovascular events and grade 3 or higher tumor lysis syndrome occurred only in the venetoclax group (14 and 7%, respectively). In conclusion, low‑dose venetoclax combined with antifungal agents appears to be less effective than standard treatment but superior to both LDAC and the I2A5 treatment regimens. Venetoclax also demonstrates a relatively low infection risk. However, careful monitoring for cardiovascular events and tumor lysis syndrome during venetoclax administration is crucial, particularly in patients with relevant medical histories.
