CLO22-037: Tumor Lysis Syndrome and Infectious Complications During Induction With Venetoclax Combined With Azacitidine or Decitabine in Patients With Acute Myeloid Leukemia

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  • 1 University of Alabama at Birmingham, Birmingham, AL

BACKGROUND: Venetoclax in combination with azacitidine or decitabine(HMA+Ven)is the standard-of-care treatment for older adults(≥75 years) or those with comorbidities precluding intensive induction therapy in newly diagnosed acute myeloid leukemia(AML).Tumor lysis syndrome(TLS) and infectious complications are two of the most concerning adverse events with this regimen. Ven ramp up is recommended to prevent TLS. However, incidence of real world TLS and infectious complications with and without Ven ramp up are unknown. METHODS: We retrospectively analyzed patients with newly diagnosed and relapsed/refractory AML who received HMA+Ven from 02/17–05/21 at our cancer center. Demographics,AML characteristics, treatment details,TLS parameters, and infectious complications were collected. TLS was defined as per Cairo-Bishop definition. Two-sided Mann-Whitney U test and Fischer’s exact test were used to evaluate differences between groups with continuous and categorical values respectively. RESULTS: 111 patients were included. Median age was 70 years (56.7% male). Most patients had intermediate (24.3%) or adverse risk(65.7%) by ELN 2017 classification. Majority (83.7%) received cycle 1 HMA+Ven inpatient. 77(69.3%) received intravenous fluids and 90(81%) received allopurinol within the first 24-48 hours of treatment initiation. Ramp-up Ven dosing was used in 49(44.1%) patients. Overall,19 patients (17.1%) met lab criteria for TLS but only 5(4.5%) had clinical TLS (acute kidney injury). 17/19(89.4%) met lab TLS criteria due to ≥25% increase from baseline while 2/19(10.5%) had significant increase with values exceeding reference ranges. Baseline white blood count (7.16 vs.2.15;p=0.03) and marrow blasts(63% vs.46%;p=0.005) were significantly higher in those who developed TLS. No significant association was found between Ven ramp up and TLS incidence. 42(37.8%) had known infections prior to starting HMA+Ven. 41 patients (36.9%) were diagnosed with febrile neutropenia; 36 (32.4%) had confirmed infection during cycle 1. CONCLUSION: In this cohort of AML patients treated with HMA+Ven, the rate of clinical TLS was low, though a notable number of patients met laboratory TLS criterion despite pre-treatment with allopurinol and fluids. While Ven ramp up did not affect TLS rates, higher leukemia burden increased the risk of TLS. Febrile neutropenia was fairly common. This data supports inpatient administration of cycle1 HMA+Ven and suggests that Ven ramp up may not be required.

CLO22-037 Table 1: Baseline characteristics and treatment details

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Corresponding Author: Sankalp Arora, MBBS