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SOHO 2025 | Selecting intensive versus lower intensity therapy in younger patients with AML
Amir Fathi, MD, MPH, Massachusetts General Hospital, Boston, MA, highlights current treatment options for younger patients with acute myeloid leukemia (AML), stating that the approved guidance for azacitidine or decitabine plus venetoclax is limited to older patients or those who are ineligible for intensive chemotherapy. For younger patients, a more gentle approach may be considered, particularly in cases of highly resistant p53-mutated AML. This interview took place at the 13th Annual Meeting of the Society of Hematologic Oncology (SOHO 2025) in Houston, TX.
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Transcript
I’m not sure there is much guidance for younger patients with acute myeloid leukemia. The currently approved guidance for azacitidine or decitabine plus venetoclax is only for older patients, patients 75 years or older, or those who are, for other reasons, not eligible for intensive upfront induction chemotherapy. So for younger patients in general, we only pursue azacitidine or decitabine plus venetoclax if they have a comorbidity that prevents the initiation of intensive chemotherapy...
I’m not sure there is much guidance for younger patients with acute myeloid leukemia. The currently approved guidance for azacitidine or decitabine plus venetoclax is only for older patients, patients 75 years or older, or those who are, for other reasons, not eligible for intensive upfront induction chemotherapy. So for younger patients in general, we only pursue azacitidine or decitabine plus venetoclax if they have a comorbidity that prevents the initiation of intensive chemotherapy. There are some scenarios where we might choose a more gentle approach, for example, the highly resistant p53 mutated subtype of AML, in which case many investigators, many clinicians use HMA and venetoclax. I am currently running a randomized Phase II study comparing intensive chemotherapy versus HMA and venetoclax in younger patients. The data is not yet presented. We hope to present it at ASH this year in December. That may shed more light on the potential promise of HMA and venetoclax as a more gentle treatment in younger patients who are traditionally intensive chemotherapy eligible or transplant eligible.
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