Venetoclax and azacitidine in combination with homoharringtonine, cytarabine, and aclarubicin for salvage therapy of relapsed/refractory T cell acute lymphoblastic leukemia.

BACKGROUND: The treatment of relapsed/refractory T cell acute lymphoblastic leukemia (R/R T-ALL) is a significant challenge in hematologic oncology, and no standard salvage treatment plan exists. Both Chinese and international clinical guidelines recommend combination chemotherapy including venetoclax.

METHODS: Efficacy and safety of venetoclax, azacitidine, homoharringtonine, cytarabine, and aclarubicin (VA-HAA) combination therapy were retrospectively analyzed in 3 patients with R/R T-ALL at the Department of Hematology, 920th Hospital of the Joint Logistics Support Force, Chinese People's Liberation Army.

RESULTS: The chemotherapy resulted in CR/CRi with negative flow MRD in all 3 patients. Quantitative negative conversion was achieved in 2 patients with fusion genes, and the frequency of monoclonal TCR gene rearrangements was significantly reduced in 1 patient. All patients received stem cell rescue after the chemotherapy. Hematologic toxicity may be manageable, with a median of 24 days for complete recovery of neutrophils (ANC) and 36 days for partial recovery of platelets. There were no major bleeding events or chemotherapy-related deaths.

CONCLUSION: VA-HAA may be an effective and safe salvage treatment for R/R T-ALL, and prospective clinical trials are needed to verify its specific clinical efficacy.