Feasibility and Safety of Venetoclax for Cytoreduction During Induction Therapy in Newly Diagnosed Acute Promyelocytic Leukemia

Objective This study aimed to evaluate the feasibility and safety of venetoclax as a cytoreductive strategy during induction therapy in newly diagnosed acute promyelocytic leukemia (APL), and to provide an exploratory description of its early efficacy. Methods This was a single‐center retrospective analysis including 29 patients newly diagnosed with APL between January 2023 and December 2025. All patients received induction therapy with all‐trans retinoic acid (ATRA) plus arsenic trioxide (ATO) and were treated with different cytoreduction strategies based on clinical decision‐making: venetoclax group ( n = 16) or conventional cytoreduction group (hydroxyurea ± anthracycline, n = 13). Results The proportion of hematologic complete recovery (HCR) at Day 28 was significantly higher in the venetoclax group than in the conventional group (93.75% vs. 46.15%, p = 0.003). The median time to HCR was shorter in the venetoclax group (26 vs. 28 days, p = 0.002). The median time to molecular complete remission (MCR) was also shorter (92 vs. 110 days, p = 0.001). In addition, the venetoclax group required significantly fewer red blood cell and platelet transfusions and had a shorter duration of hospitalization. There was no statistically significant difference in the incidence of differentiation syndrome (DS) between the two groups. Conclusion Venetoclax appears to be a feasible and safe cytoreductive option during induction therapy in APL and may be associated with faster hematologic recovery. These findings require further validation in prospective studies.