How do you manage persistent cytopenias in patients with AML who achieve a complete remission with incomplete count recovery after venetoclax and HMA?

This is an important question. How to manage cytopenias on HMA + venetoclax-based regimens is one of the biggest conundrums in the management of AML. The clinical trials to date have not uniformly answered this question based on level 1 evidence. These recommendations are mainly based on anecdotal data and clinical experience. A bone marrow biopsy after cycle 1 of HMA + venetoclax is critical (Dinardo et al., Blood 2019). I recommend a bone marrow biopsy between days 24-28 of cycle 1, so that th...

This is a challenging and frequent question regarding the upfront use of venetoclax and hypomethylating agents in older individuals. Our practice is as outlined by @Dr. First Last, except that we perform a bone marrow biopsy on day 21 of first cycle of therapy. If there is evidence of cytoreduction with less than 5 percent blasts, I would hold the venetoclax and administer G-CSF for those individuals with profound cytopenia to hasten WBC recovery and minimize or mitigate the risk of neutropenic ...