Venetoclax combined with modified intensive chemotherapy in newly diagnosed acute myeloid leukemia: a propensity score-matched analysis

Background There were several explorations to combine venetoclax with standard 3 + 7 regimen or modified intensive chemotherapy. However, few of them included direct comparisons between different regimens. Method The study retrospectively collected the information about newly diagnosed AML patients of which 100 induced by the standard 3 + 7 regimen, 22 by the 3 + 7+ventoclax regimen and 19 by the 2 + 5+ventoclax regimen. We performed propensity score-matched analysis to the 3 + 7+ventoclax group and the historical standard 3 + 7 group to adjust age, Charlson comorbidity index and ELN risk category. Furthermore, we tried to explored the feasibility of the 2 + 5+venetoclax regimen to adapt for the older or patients with more complication by comparing to the 3 + 7+venetoclax group. Result Compared with the standard 3 + 7 therapy, the complete remission/complete remission with incomplete hematologic recovery (CR/CRi) rate was higher in the 3 + 7+venetoclax group (90.91% vs 63.33%, p = 0.015) and the event-free survival (EFS) was prolonged (P = 0.0072). Besides, venetoclax induced deeper remission for patients at ELN favorable risk. The superiority causing by 3 + 7+V regimen still existed among patients classified as ELN adverse or intermediate risk group. 36.84% of the 2 + 5+ventoclax group aged 60 years old or older. There was no significant difference in CR/CRi rate, OS or EFS between the 2 + 5+venetoclax group and the 3 + 7+venetoclax group. Conclusion The addition of venetoclax to the standard 3 + 7 induction therapy could notably improve the outcome of untreated AML. And the comparable efficiency with considerable security by administrating 2 + 5+venetoclax regimen, make it possible to substitute for the 3 + 7+V regimen as induction treatment, especially for elder patients.