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ASH 2025 | The challenges of venetoclax dosing in AML
In this video, Cristina Papayannidis, MD, PhD, University of Bologna, Bologna, Italy, briefly discusses the challenge of treating patients with acute myeloid leukemia (AML) with the standard venetoclax dosage due to hematological toxicity, highlighting that a reduced schedule is commonly used. Dr Papayannidis notes that studies presented at the ASH 2025 meeting indicate that reduced dosing is often necessary, particularly in older patients. Additionally, new data suggest that venetoclax-based regimens may benefit newly diagnosed patients fit for standard chemotherapy. This interview took place at the 67th ASH Annual Meeting and Exposition, held in Orlando, FL.
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Transcript
Well, this is another important point. I think that today in clinical practice, it’s very, very difficult to treat patients with the standard and labeled dosage. I mean, the 28 days of venetoclax due to hematological toxicity in neutropenia, thrombocytopenia, in the majority of the cases, we are able to give no more than 21 days of venetoclax, at least during the first course and also during the following ones...
Well, this is another important point. I think that today in clinical practice, it’s very, very difficult to treat patients with the standard and labeled dosage. I mean, the 28 days of venetoclax due to hematological toxicity in neutropenia, thrombocytopenia, in the majority of the cases, we are able to give no more than 21 days of venetoclax, at least during the first course and also during the following ones. Many studies have been presented at ASH, and the major finding is that, in particular in the very elderly patient population, the most frequent dose is no more than seven days of venetoclax, in some cases 14, but no more than this.
The other important issue and other important point is to try to understand if not only elderly and unfit patients may benefit from a venetoclax-based approach in combination with hypomethylating agents, but also newly diagnosed patients fit for standard chemotherapy. In particular, the PARADIGM study presented during the plenary session demonstrated that also in newly diagnosed fit patients with AML, non-low risk, a low-intensity approach with azacitidine and venetoclax may give a more important benefit compared to the standard of care in terms of 3 plus 7 approach. So it’s something that needs to be confirmed in other studies, but it’s a very, very important novelty.
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