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Venetoclax-Based Therapy and Azole Antifungals in AML: Effects on Blood Cell Counts

By: Vanessa A. Carter, BS
Posted: Wednesday, May 26, 2021

Marina Y. Konopleva, MD, PhD, of The University of Texas MD Anderson Cancer Center, Houston, and colleagues analyzed the duration of myelosuppression in patients with acute myeloid leukemia (AML) being treated with venetoclax and a hypomethylating agent with or without prophylaxis with azole antifungals. They discovered that the drug combination resulted in thrombocytopenia and neutropenia, with the former prolonged in those on azoles. Their results, published in the journal Cancer, also demonstrated a consistent safety profile for each azole when combined with venetoclax.

A total of 64 patients with newly diagnosed AML were enrolled in this study; 47 received an azole (20, isavuconazole; 17, posaconazole; 9, voriconazole; 1, fluconazole). Participants were administered 200 mg of venetoclax if an azole was added, and 400 mg if it was not, along with either azacitidine (n = 6) or decitabine (n = 58).

The median patient age was 72 years. De novo AML affected 44 patients, and the remaining patients had either therapy-related AML or secondary AML. There appeared to be no significant difference in the median time to absolute neutrophil count recovery for individuals who did and did not receive an azole (37 vs. 39 days). However, the median time to platelet count recovery was significantly shorter for participants not receiving azoles (22 days) than those who did (28 days, P = .01). The median times to absolute neutrophil count recovery (35 vs. 38 days) and platelet recovery (26 vs. 32 days) were similar with posaconazole and voriconazole, respectively. A majority of patients experienced neutropenic fever (55%), and 28 patients had infections such as pneumonia, cellulitis, bacteremia from gram-positive or gram-negative organisms, sinusitis, and pharyngitis.

Disclosure: For full disclosures of the study authors, visit acsjournals.onlinelibrary.wiley.com.


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