(PB2488) Chart review study on the real-world cytopenia management of patients with acute myeloid leukemia treated with venetoclax and hypomethylating agents

A retrospective chart review study was conducted utilizing electronic medical record (EMR) data from the ConcertAI Oncology Dataset. The study cohort included 200 AML patients who initiated VEN+HMA therapy within 120 days of initial diagnosis in the structured EMR data. Patients were selected through stratified random sampling. CR was determined based on either physician documentation or bone marrow blasts <5% during the VEN+HMA treatment. Patient characteristics were examined using the structured data. Treatment modification post-CR was assessed based on physician documentation in the unstructured EMR data. Modifications due to cytopenia were also confirmed through physician notes.

Among the 200 cases reviewed, 197 patients had confirmed AML diagnosis and 165 received VEN+HMA as first-line (1L) treatment, including 92 patients treated with subcutaneous or intravenous (IV) azacitidine and 73 with IV decitabine. The year of initial AML diagnosis ranged from 2017 to 2023. The median age was 75 years; 37% were female, 75% were White, and 91% received care in a community setting. Approximately 19% had an ECOG performance status of 2 or higher, and 28% had a Charlson Comorbidity Index (CCI) score of 2 or higher. CR was achieved in 88 out of 165 (53%) patients. Among these 88 patients, 76 (86.4%) experienced at least one treatment modification following CR, with cytopenia as the reason for treatment modification in 63 (82.9% of 76). The majority of patients (59.1% of 88) had dose modifications in both VEN and HMA, while 20.5% had dose modifications in VEN only, and 6.8% had modifications in HMA only. The most common treatment modification was delayed subsequent treatment cycle of VEN (58.0%) or HMA (51.1%), followed by decreased dosing duration of VEN (27.3%) or HMA (11.4%). Reductions in dose strength or treatment discontinuation were less frequent: HMA was dose-reduced in 4 patients (4.5%) and VEN in 8 patients (9.1%); HMA was discontinued in 5 patients (5.7%) and VEN in 9 patients (10.2%). Among the 76 patients who had dose modifications, 49 (64.5%) had evidence of another cytopenia event after the dose modifications (Figure 1).