Venetoclax combined with hypomethylating agents or low-dose cytarabine as induction chemotherapy for patients with untreated acute myeloid leukemia ineligible for intensive chemotherapy: a systematic review and meta-analysis

The treatment of patients with acute myeloid leukemia (AML) who are intolerable to intensive chemotherapy remains to be further explored. Recent studies have shown that venetoclax combined with hypomethylating agents (HMAs) or low-dose cytarabine (LDAC) may have a good effect on these patients. Given the lack of a comprehensive analysis of the efficacy and safety of such treatment, the aim of this review was to assess the efficacy and safety of venetoclax plus HMAs or LDAC for untreated AML patients who are ineligible for intensive chemotherapy. A systematic literature review was conducted in the PubMed, Embase, and Cochrane databases up to April 30, 2021. A total of four clinical trials including 440 patients were eligible for this meta-analysis. The pooled complete remission (CR) and complete remission plus complete remission with incomplete blood count recovery (CR/CRi) rates were 0.40 (95% CI 0.26-0.55) and 0.64 (95% CI 0.49-0.77), respectively. The median overall survival time was 11.7 (95% CI 10.15-14.18) months. The most common adverse events (AEs) of any grade were nausea (57%), diarrhea (42%), and hypokalemia (36%). The most common AEs of grade >= 3 were febrile neutropenia (38%) and thrombocytopenia (35%). The pooled 30-day mortality rate in our study was 5%. The improved remission rate and tolerance make venetoclax combined with HMAs or LDAC an attractive induction therapy option for untreated AML patients who are unsuitable for intensive chemotherapy.

Automated summary

Venetoclax combined with hypomethylating agents or low-dose cytarabine may be an effective and well-tolerated treatment option for untreated AML patients who cannot tolerate intensive chemotherapy. A meta-analysis of four clinical trials showed higher complete remission rates and median overall survival time in this treatment combination, with common adverse events including nausea, diarrhea, and hypokalemia.