Venetoclax Combined With Azacitidine For Frail Elderly Acute Myeloid Leukemia: A Case Report And Review Of Literature

Objective:To investigate the application of BCL-2 inhibitor venetoclax based therapies in elderly AML patients,and to analyze the mechanism of action,clinical trials,adverse reactions and its application in other hematological malignancies.Methods:In this paper,we report an elderly AML patient treated with venetoclax and azacitidine,and reviews the related literature.Results:The patient was hospitalized because of rash for more thanone month and intermittent fever for half a month on August 1,2020.Based on the results of bone marrow smear,biopsy,flow cytometry andnext-generation sequencing,she was definitely diagnosed as acute monoblastic leukemia.On admission,she was accompanied by severe pulmonary infection,hypertension,atrial fibrillation,and previous cerebral infarction.The patient was compre-hensively evaluated and considered to be unable to tolerate intensive chemotherapy,and was given induction therapywith venetoclax combined with azacitidine.According to the patient’s clinical situation,venetoclax was adjusted to 14 days.The patient achieved Complete remission on 28 days,and the Hematologic Recovery on 8 days after thetreatment(neutrophil≥0.5x10~9/L and platelet≥50x10~9/L).It is currently in sustained remission with a progression-free survival of 7 months.Conclusions:1.For the elderly patients with leukemia who are older and not suitable for intensive treatment,the combination of venetoclax and azacitidine has high remission rate and long overall survival.2.For patients who can not tolerate the 28-day course of venetoclax,shortening the duration of treatment with venetoclax to 14 days with azacitidine at the same target dose will result in better survival with less side effects,so based on venetoclax combined with azacitidine scheme can be adjusted for individualization.3.The patients with IDH1/2,FIT3-ITD and NPM1 mutations have high remission rate and long survival time with venetoclax and azacitidine,but NPM1 mutation is associated with excellent survival prospects and durable molecular remission after venetoclax based combination therapy.4.For the treatment of elderly patients with acute leukemia,there is no unified standard at home and abroad,and elderly patients have a series of problems,such as basic diseases,organ function decline,,adverse cytogenetic changes and difficulty in tolerating intensive chemotherapy.Therefore,it is particularly important to evaluate the prognosis of patients to help clinicians make treatment decisions.