ABSTRACT Relapse after allogeneic hematopoietic cell transplantation (alloHCT) remains a challenge for patients with AML and MDS, and salvage therapy in this setting is not standardized. Given the efficacy of hypomethylating agents and venetoclax (HMA-VEN) in the frontline and relapsed settings, we evaluated the use of this therapy for post alloHCT relapse. Eighty-three patients with AML (n = 69) or MDS (n=14) who relapsed after alloHCT were included in this retrospective analysis. The median time to relapse after alloHCT was 7.0 months. A majority of patients (55%) had prior venetoclax (VEN) exposure, and 28% of these patients had previously experienced treatment failure with a VEN-based regimen. HMA-VEN treatment emergent toxicities were predominantly neutropenia and thrombocytopenia; however, the 30-day mortality was only 3.6%. There were 3 deaths within 30 days due to infectious complications. HMA-VEN led to a CR/CRi in 48% of patients with 58% of these patients achieving MRD negativity. In multivariable analysis, ELN 2024 genetic risk stratification was a predictor of survival outcome. Additionally, prior venetoclax failure was not a predictor of overall survival. In conclusion, HMA-VEN provides an efficacious and well tolerated option for post-alloHCT AML or MDS relapse regardless of their prior therapy and may allow responders to undergo a second alloHCT with curative intent.
Samuels et al. (Mon,) studied this question.
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