The impact of venetoclax based regimens in the preemptive of measurable residual disease in acute myeloid leukemia

To The Editor: The role of measurable residual disease (MRD) in prognosis and treatment in acute myeloid leukemia (AML) is evolving. Studies have demonstrated the correlation between MRD and risks of relapse in adult AML: persistently positive MRD after induction is associated with a high risk of relapse, and these patients should consider allogeneic transplantation (allo-Hematopoietic StemCell Transplantation (HSCT)) and clinical trial, even in favorable-risk groups. However, because of the financial issue or lack of suitable transplant donors, many of the patients could not receive allo-HSCT, so how to prolong the relapse-free survival of these patients remains a challenge. Platzbecker et al treated MRD-positive patients with azacytidine (AZA), and found pre-emptive therapy with AZA can prevent or substantially delay hematological relapse in MRD-positive patients with MDS (myelodysplastic syndrome) or AML who are at a high risk of relapse. What’s more, the application of venetoclax has markedly altered the treatment landscape in AML and provided new opportunities, and preclinical studies have indicated that venetoclax could enhance the activity of anti-leukemic drugs such as HMA (hypomethylating agents), cytarabine, and idarubicin. Moreover, venetoclax with AZA has superior efficacy compared to AZA alone in the treatment of elderly unfit AML patients. Moreover, MRD negative rate after the induction therapy of venetoclax with HMA is much higher (54%–81%) than traditional chemotherapies. Hence, we consider that venetoclax-based regimens could be an efficacious pre-emptive option in patients with persistent MRD positive after induction