Venetoclax plus modified-intensity Idarubicin and Cytarabine treatment as first-line treatment for newly diagnosed pediatric acute myeloid leukemia

Abstract Purpose: Venetoclax (VEN) has shown excellent activity in eliminating acute myeloid leukemia (AML) blasts in preclinical and clinical trials, but clinical data in pediatric newly diagnosed AML (ND-AML) remain limited. We evaluated VEN plus modified-intensity idarubicin and cytarabine chemotherapy (VIA) in childhood ND-AML. Patients and Methods: In an open-label, single-arm, multicenter prospective clinical trial, 65 pediatric patients with ND-AML received VIA induction. Consolidation was guided on response to induction and individualized risk stratification. Primary end point was complete remission and measurable residual disease (MRD) response rates. Results: After induction cycle 1, complete remission and MRD negativity was 90.8% and 78.5%, increasing to 96.8% and 87.3% following induction cycle 2. A total of 28 (43.2%) patients underwent hematopoietic stem cell transplantation without engraftment failure. Patients with core-binding factor (CBF) AML [t(8;21) and inv(16)/t(16;16)] achieved a favorable response rate, but the median log10 reduction of transcript levels was suboptimal [-1.7 (cycle 1) and -2.6 (cycle 2) for RUNX1::RUNX1T1 and -2.3 and -2.5 for CBFB::MYH11]. Disease relapse was frequently observed in KIT mutation, RUNX1::RUNX1T1, and CBFB::MYH11. The most common grade 3 to 4 toxicities were hematologic toxicities and febrile neutropenia. No treatment-related deaths occurred. With a median follow-up of 15.7 months, the estimated 12-month overall survival and event-free survival was 92.3% (95% confidence interval, 86.0–99.8) and 79.1% (95% confidence interval, 69.6–90.0). MRD negativity after cycle 1 correlated with superior long-term survival (P < 0.001). Conclusions: The VIA regimen is highly effective and relatively safe in children with ND-AML, with deep remission and favorable survival outcomes observed.