Feasibility and Safety of Venetoclax for Cytoreduction During Induction Therapy in Newly Diagnosed Acute Promyelocytic Leukemia.

OBJECTIVE

This study aimed to evaluate the feasibility and safety of venetoclax as a cytoreductive strategy during induction therapy in newly diagnosed acute promyelocytic leukemia (APL), and to provide an exploratory description of its early efficacy.

METHODS

This was a single-center retrospective analysis including 29 patients newly diagnosed with APL between January 2023 and December 2025. All patients received induction therapy with all-trans retinoic acid (ATRA) plus arsenic trioxide (ATO) and were treated with different cytoreduction strategies based on clinical decision-making: venetoclax group (n = 16) or conventional cytoreduction group (hydroxyurea ± anthracycline, n = 13).

RESULTS

The proportion of hematologic complete recovery (HCR) at Day 28 was significantly higher in the venetoclax group than in the conventional group (93.75% vs. 46.15%, p = 0.003). The median time to HCR was shorter in the venetoclax group (26 vs. 28 days, p = 0.002). The median time to molecular complete remission (MCR) was also shorter (92 vs. 110 days, p = 0.001). In addition, the venetoclax group required significantly fewer red blood cell and platelet transfusions and had a shorter duration of hospitalization. There was no statistically significant difference in the incidence of differentiation syndrome (DS) between the two groups.

CONCLUSION

Venetoclax appears to be a feasible and safe cytoreductive option during induction therapy in APL and may be associated with faster hematologic recovery. These findings require further validation in prospective studies.