EHA 2025 | Hot topics in AML from EHA 2025: menin inhibitors, adjusting venetoclax dose, & maintenance therapy

I had the opportunity to be involved in several sessions at EHA 2025 and there were several quite consistent themes that came up as I would say the hottest ones in AML. So hot drug number one I would say is not a particular agent but rather the class of menin inhibitors. Throughout the meeting there have been sessions that showed new and emerging data on several different menin inhibitors, which are quite promising for patients with NPM1 and KMT2A abnormalities. NPM1 is hard because we’re doing pretty well with existing therapy. That’s not to say we can’t do better. Of course, we can and want to. But at least for initial induction, both in the intensive and the non-intensive settings, there are very high rates of remission. So the question is, how will the menin inhibitors be incorporated into the existing backbones to make things better? We started seeing some preliminary data on several. I do not have a favorite menin inhibitor yet. They are all tracking quite well in terms of efficacy. But we’re waiting to see which ones result in the highest rates of MRD negativity with the most favorable toxicity profile. And everybody wants to know what’s happening with menin inhibitors and when will we get one. Revumenib, of course, already has a label in relapsed/refractory disease for KMT2A rearranged patients. Those patients are not in as good shape as the NPM1, so those patients have dangerous disease that actually is more challenging to both get into remission and also with high rates of relapse. So in that subgroup, we are anxiously awaiting, again, combination therapies to really improve outcomes for those patients. Another topic that came up very frequently, I mentioned in my earlier comments about dose adjustments of venetoclax. Venetoclax is the standard of care, how many days to give. And I think there was emphasis throughout the sessions to be careful to try to have the patients, especially the high benefit patients, make sure that we’re not making random adjustments, but to try to follow the best data that we have in terms of the post-remission dosing. Also asked by many clinicians was the dosing in combination with azole antifungals. Quite a bit of controversy there as to whether doctors are using azoles. Some yes, some no. We argue about it all the time. The main theme is that if it is practice in your center to use an azole antifungal to reduce the dose of venetoclax according to the package insert, otherwise you’re going to get significant myelosuppression. Doctors ask frequently, do you absolutely need azole prophylaxis for your patients? And the answer is no, but you should discuss it with your infectious disease colleagues and see how the outcomes are at your center with and without such prophylaxis. At my center, we do routinely use it throughout induction, and we do make dose adjustments in the venetoclax. Again, the dose adjustments are for the antifungals. There are also schedule adjustments that can happen in the post-remission setting to mitigate myelosuppression. So doctors, again, a little bit of clarification required in when are you changing the dose? That’s in combination with other medications, primarily antifungals. When are you reducing the schedule? Trying not to, but in that post-remission setting when needed. Third topic that came up a lot was maintenance in AML. Once you get into remission, you want to stay there? Better quality of life, longer life for the patients. How do you stay in remission? So there was a lot of discussion about transplants becoming safer and more accessible for patients. So I would say every single year there is an opportunity to move more patients into transplant more safely than before and with better donor accessibility with the promising changes for haploidentical and other alternate donor sources getting better and safer. Not everybody can go to transplant. So for low intensity or less intensively treated patients, we tend to have ongoing cycles, mostly of a hypomethylating agent and venetoclax. And then for patients who get intensive chemotherapy but can’t go on to a transplant, for the FLT3 mutated patients, those patients are typically getting a FLT3 inhibitor. And for other patients, oral azacitidine is what is approved for patients in remission after intensive therapy who aren’t going on to a transplant. And there was a lot of discussion of oral azacitidine in that setting.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.