The risks of invasive fungal infections in patients treated with venetoclax and hypomethylating agents for acute myeloid leukemia

The study examined the risks of invasive fungal infections (IFIs) in patients with acute myeloid leukemia (AML), who were treated with venetoclax (Venclexta) and hypomethylating agents (VEN-HMAs). The authors found that the occurrence of IFIs was low during VEN-HMA treatment.

Venetoclax is a targeted therapy. It blocks the action of a certain protein that helps cancer cells grow. HMAs are chemotherapy drugs such as decitabine (Dacogen) and azacitidine (Vidaza). They work by killing cancer cells. Patients with newly diagnosed and relapsed/refractory (r/r) AML can be effectively treated with VEN-HMAs. 

However, the combination of VEN-HMAs also cause severe loss of mature blood cells in patients with AML. This exposes them to IFIs. However, the risk factors for IFIs in patients with AML treated with VEN-HMAs are still under investigation.

This study analyzed the records of 119 adult patients with AML. All patients had received VEN-HMA therapy. Patients also received different antifungal treatments for preventing further IFIs. These included Micafungin (Mycamine) in 38% of patients, azoles (kill fungi by damaging their cell membranes) such as fluconazole (Diflucan) or posaconazole (Noxafil) in 41% of patients, and none in 21% of patients.

Responders to VEN-HMA therapy were followed-up for 210 days and non-responders for 85 days, on average. 15 (12.6%) patients had an IFI at an average of 72 days after starting therapy. 

Patients whose leukemia did not disappear after VEN-HMA therapy had more IFIs compared with patients who did respond (22% vs 6%). Also, IFIs were more common among patients with r/r AML (19%) compared with the ones with newly diagnosed AML (5%). The type of antifungal agents used and patients’ age did not influence the occurrence of IFIs.

The study concluded that the overall risk of IFIs was low during VEN-HMA therapy for AML.

This study was retrospective, meaning it looked back in time to analyze patients’ data. It also did not talk about whether the duration of antifungal treatment affected the risks for IFIs. Further studies are needed for stronger evidence.