Clinical Report: Oral Maintenance Therapy in AML/MDS Patients

Overview

Data presented by Dr. Jacqueline Garcia suggests that oral maintenance therapy with venetoclax and decitabine/cedazuridine is safe and feasible for high-risk AML/MDS patients post-HCT, potentially reducing relapse rates. The study demonstrated encouraging survival outcomes and tolerability.

Background

Acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) are challenging conditions, particularly in older patients who often undergo reduced intensity conditioning (RIC) transplantation. Patients with measurable residual disease (MRD) prior to transplantation face a heightened risk of relapse. Maintenance therapy strategies are being explored to improve outcomes in this vulnerable population.

Data Highlights

Key Findings

• Oral maintenance therapy with venetoclax and decitabine/cedazuridine was well tolerated in a cohort of 30 patients.
• Median cycles delivered were 8, aligning with the planned treatment regimen.
• No grade 3 or 4 non-hematologic toxicities were reported; expected hematologic toxicities were manageable.
• 1-year overall survival was reported at 81%, with a progression-free survival of 73%.
• The cumulative incidence of relapse at 1 year was 27%, indicating potential efficacy in reducing relapse rates.

Clinical Implications

The findings support the use of an oral maintenance therapy regimen in high-risk AML/MDS patients post-transplant, which may improve patient outcomes without significant toxicity. Clinicians should consider this approach in managing patients with MRD prior to transplantation.

Conclusion

The study highlights the safety and feasibility of an oral maintenance therapy strategy in high-risk AML/MDS patients, suggesting a promising avenue for improving post-transplant outcomes.

References

1. Amir T. Fathi, MD, The ASCO Post, 2018 -- EXPERT POINT OF VIEW: Amir T. Fathi, MD
2. The ASCO Post, 2018 -- Data Favoring Maintenance Therapy in Older Patients With AML Accumulate
3. The ASCO Post, 2025 -- Study Finds Novel Triplet Regimen Safe and Effective for Patients With Higher-Risk MDS and CMML
4. Blood Cancer Journal, 2017 -- Alternating Azacitidine and Lenalidomide as Maintenance Therapy in Elderly Patients with Poor Prognosis Acute Myeloid Leukemia
5. Sorafenib Maintenance After Allogeneic Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia With FLT3-Internal Tandem Duplication Mutation (SORMAIN) - PubMed
6. Maintenance therapy with oral decitabine plus cedazuridine after allogeneic stem cell transplantation for myelodysplastic syndrome - PMC
7. Sorafenib Maintenance After Allogeneic Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia With FLT3-Internal Tandem Duplication Mutation (SORMAIN) - PubMed
8. Maintenance therapy with oral decitabine plus cedazuridine after allogeneic stem cell transplantation for myelodysplastic syndrome - PMC