# Case Report: Venetoclax combined with hypomethylating agents for the treatment of newly diagnosed with mixed-phenotype acute leukemia and a literature review

## TL;DR

This case report shows that combining venetoclax with hypomethylating agents can effectively treat mixed-phenotype acute leukemia with good remission rates.

## Contribution

The study presents a novel retrospective analysis of venetoclax plus hypomethylating agents in treating newly diagnosed mixed-phenotype acute leukemia.

## Key findings

- All four MPAL patients achieved complete remission after one cycle of venetoclax combined with hypomethylating agents.
- Two patients developed infections during treatment but were successfully managed with antimicrobial therapy and supportive care.
- The regimen was well tolerated by two patients without significant adverse events.

## Abstract

To investigate the efficacy and safety of venetoclax (Ven) in combination with hypomethylating agents (HMAs) for the treatment of mixed-phenotype acute leukemia (MPAL).

From July 2023 to April 2025, 4 newly diagnosed MPAL patients treated with Ven combined with HMAs at the Affiliated Cancer Hospital of Zhengzhou University, Luoyang Central Hospital and Anyang Regional Hospital were retrospectively analyzed to determine the efficacy and safety of this treatment. The relevant published studies were reviewed.

This study included four patients (2 males, 2 females) with a median age of 47 years (range: 40–80 years). Three patients were classified as having B/myeloid MPAL, and one was classified as having T/myeloid MPAL. All patients achieved complete remission (CR) after one cycle of venetoclax combined with HMAs. Notably, Patient 3, who tested positive for the BCR::ABL1 fusion gene, received additional tyrosine kinase inhibitor (TKI) therapy. The median duration of myelosuppression during induction therapy was 26 days (range: 7–36). Patients 1 and 4 developed infections during induction, which were controlled with aggressive antimicrobial treatment and supportive care. In contrast, Patients 2 and 3 tolerated the regimen well without significant adverse events.

The treatment of MPAL with Ven combined with HMAs achieved a high remission rate and can be used as an alternative treatment for MPAL.