What question did this study set out to answer?

To examine predictors of post-transplant survival in newly diagnosed acute myeloid leukemia patients treated with venetoclax and hypomethylating agents.

May 29, 2026

Older age as a predictor of post-transplant survival in newly diagnosed acute myeloid leukemia treated with HMA-venetoclax.

Key Points

To examine predictors of post-transplant survival in newly diagnosed acute myeloid leukemia patients treated with venetoclax and hypomethylating agents.
Retrospective study of 111 ND-AML patients who received upfront venetoclax and HMA followed by allogeneic stem cell transplant.
Evaluated post-transplant survival, relapse rate, and non-relapse mortality rates over a median follow-up of 30 months.
Multivariate analysis was conducted considering patient age, genetic profile, and transplant characteristics.
Median post-transplant survival was not reached with a 1-year survival rate of 69%.
Age ≥65 years was independently associated with improved post-transplant survival (p<0.01).
Patients <65 years had higher post-transplant relapse rates compared to those aged ≥65 years (36% vs 18%, p=0.01).

Abstract

6530 Background: Venetoclax (Ven) plus hypomethylating agents (HMA) is standard frontline therapy for newly diagnosed AML (ND-AML) patients unfit for intensive chemotherapy and is also being considered in younger and fit patients (Fathi, Blood 2025). However, consolidation with allogeneic stem cell transplant (ASCT) is often required to secure durable remission. The current study examines predictors of post-transplant survival (PTS) in the particular scenario. Methods: ND-AML patients who received upfront Ven+HMA and underwent ASCT were retrospectively studied. PTS, relapse rate, and non-relapse mortality (NRM) were evaluated. Results: 111 ND-AML patients (58% male, 60% secondary/therapy-related, median age 70 37-80 years) received median 3 cycles of Ven-HMA. 22% had complex karyotype. Mutations at diagnosis included RUNX1 (18%), SRSF2 (17%), TP53 (16%), ASXL1 , IDH2 , K/NRAS and TET2 (14% each), STAG2 (11%), DNMT3A (8%) and at time of ASCT (N=78 evaluable); RUNX1 (8%), NPM1 (6%), TP53 and ASXL1 (5% each), and SRSF2 and TET2 (4% each). At ASCT, all patients were in CR/CRi; 88% after Ven-HMA and 12% after additional bridging therapy. MRD by flow cytometry was detected in 18 (24%) of 76 evaluable patients and complex karyotype in 8 (9%) of 94. Donors were mostly HLA-matched unrelated (75%), with 51% receiving fludarabine/melphalan conditioning and 67% post-transplant cyclophosphamide (PTCy). At a median follow-up of 30 months, 42 patients (38%) have died including 18 (40%) from relapse. Median PTS was not reached (NR) with 1-2-3-year survival of 69%/60%57%. On multivariate analysis, age ≥65 years (median NR vs 10 months p0.1). Patients 65 years), including >75 years, was independently associated with superior PTS in ND-AML patients receiving Ven-HMA. By contrast, PTS was not affected by genetic profile at the time of ASCT, donor type, conditioning regimen, or GVHD prophylaxis.

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