Venetoclax/Venetoclax (Vekela) 28-day azacitidine 7-day combination therapy regimen

Venetoclax is a selective BCL-2 inhibitor that induces apoptosis in acute myeloid leukemia (AML) cells by inhibiting the anti-apoptotic protein BCL-2. Azacitidine (Azacitidine) is a demethylating agent/chemotherapy drug that can restore the expression of tumor suppressor genes and inhibit the proliferation of leukemia cells. The combined use of the two can produce a synergistic anti-leukemia effect, which is especially suitable for elderly or patients with underlying diseases who are not suitable for high-intensity chemotherapy.

The commonly used combination regimen is 28 days as a cycle, in which azacitidine is injected intravenously or subcutaneously 7 days before, and the dose is usually 75 mg/m²/d. In combination regimens, venetoclax is usually taken orally once daily and gradually titrated to a target dose (generally 400 mg or 600 mg daily) based on hematological tolerance to reduce the risk of tumor lysis syndrome (TLS).

During the course of medication, it is necessary to monitor hematology, liver and kidney function, and electrolytes such as serum potassium and phosphorus. Especially during the increasing stage of venetoclax, prevention of TLS is required. Adequate hydration and uricase and other drugs can be used. During treatment, the dose needs to be adjusted according to changes in blood images. If severe neutropenia or infection occurs, the administration of venetoclax or azacitidine can be appropriately delayed.

The combination regimen is repeated periodically, and every 28 days constitutes a cycle. It is usually recommended to use it continuously for at least 2–6 cycles, and adjust according to efficacy and tolerability. Bone marrow puncture or imaging examinations should be performed regularly during the course of treatment to evaluate the treatment response to ensure that patients can obtain the maximum therapeutic effect while effectively controlling the risk of side effects and complications.

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