Leukemia research · 2026
Efficacy of hypomethylating agents in combination with venetoclax in relapsed/refractory acute myeloid leukemia: A systematic review and meta-analysis.
Систематический обзорСтатьяМетаанализНазвание и аннотация: Перевод в очереди
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Salter Brittany, Ge Sarah, Berg Tobias, Garcia-Horton Alejandro
Аннотация
BACKGROUND: Despite recent advances in the treatment of acute myeloid leukemia (AML), primary refractory disease and relapse (R/R) remain frequent, and there is no clearly established standard of care in this setting. While the combination of hypomethylating agents (HMA) with venetoclax (VEN) is a standard front-line therapy for patient's ineligible for intensive chemotherapy, its efficacy in the R/R setting remains poorly defined. The purpose of this systematic review and meta-analysis was to review the efficacy and safety of HMA/VEN for management of R/R AML.
METHODS: A systematic review was conducted using Embase and MEDLINE, identifying studies published between 2017 and 2025. Inclusion required adult R/R AML cohorts with at least 20 participants. The primary focus included treatment response and adverse events.
RESULTS: A total of 32 studies (N = 2289) were included. Patients were heavily pretreated, with 34% of patients having prior HMA exposure. Pooled efficacy estimates showed: complete remission (CR) 26% (95% CI: 24-48%), composite CR (CR/CRi) 43% (95% CI: 41-46%), overall response rate (ORR) 50% (95% CI: 48-53%), and measurable residual disease (MRD) negativity 42% (95% CI: 38-46%). The median overall survival (OS) was 8 months (IQR: 3-25) with one-year OS 40% (IQR: 23-55). Safety concerns were notable, with significant grade ≥ 3 toxicities, including febrile neutropenia, infection, and cytopenia. No significant publication bias was observed.
CONCLUSION: This study demonstrates that HMA/VEN is a potential re-induction regimen for patients with R/R AML. However, the high statistical heterogeneity identified underscores the need for further randomized studies to establish efficacy compared to more intensive salvage regimens.
METHODS: A systematic review was conducted using Embase and MEDLINE, identifying studies published between 2017 and 2025. Inclusion required adult R/R AML cohorts with at least 20 participants. The primary focus included treatment response and adverse events.
RESULTS: A total of 32 studies (N = 2289) were included. Patients were heavily pretreated, with 34% of patients having prior HMA exposure. Pooled efficacy estimates showed: complete remission (CR) 26% (95% CI: 24-48%), composite CR (CR/CRi) 43% (95% CI: 41-46%), overall response rate (ORR) 50% (95% CI: 48-53%), and measurable residual disease (MRD) negativity 42% (95% CI: 38-46%). The median overall survival (OS) was 8 months (IQR: 3-25) with one-year OS 40% (IQR: 23-55). Safety concerns were notable, with significant grade ≥ 3 toxicities, including febrile neutropenia, infection, and cytopenia. No significant publication bias was observed.
CONCLUSION: This study demonstrates that HMA/VEN is a potential re-induction regimen for patients with R/R AML. However, the high statistical heterogeneity identified underscores the need for further randomized studies to establish efficacy compared to more intensive salvage regimens.