Treatment-Free Remission After Ceasing Venetoclax-Based Therapy in Patients With Acute Myeloid Leukemia

Authors

Chong Chyn Chua
Danielle Hammond
Andrew Kent
Ing Soo Tiong
Marina Y Konopleva
Daniel A Pollyea
Courtney D DiNardo
Andrew H Wei

Publication Date

7-12-2022

Journal

Blood Advances

Abstract

The clinical benefit of adding venetoclax (VEN) to hypomethylating agents or low-dose cytarabine in older and/or unfit patients with newly diagnosed acute myeloid leukemia (AML) has been confirmed in phase 3 studies. With the increased uptake of VEN-based therapies for patients with AML, a pertinent question is whether treatment can be safely ceased among patients who have achieved sustained remission. We hypothesized that a proportion of patients opting to cease therapy may benefit from a treatment-free remission (TFR) period without indefinite treatment. We report the retrospective outcomes of 29 patients in remission for a minimum of 12 months on VEN-based therapy, with 55% continuing therapy until disease progression and 45% electively ceasing treatment (STOP). With follow-up exceeding 5 years, we observed a median TFR lasting 45.8 months among the STOP cohort, with >50% of patients still in sustained remission at the data cutoff. The risk of relapse and duration of relapse-free and overall survival were similar between the 2 cohorts. Factors favoring sustained TFR within the cohort included NPM1 and/or IDH2 mutation at diagnosis, complete remission without measurable residual disease, and at least 12 months of VEN-based combination therapy prior to treatment cessation.

Keywords

Aged, Antineoplastic Combined Chemotherapy Protocols, Bridged Bicyclo Compounds, Heterocyclic, Humans, Leukemia, Myeloid, Acute, Retrospective Studies, Sulfonamides

DOI

10.1182/bloodadvances.2022007083

PMID

35511730

PMCID

PMC9278306

PubMedCentral® Posted Date

7-5-2022

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes