# Hypomethylating agents alone or in combination with venetoclax in very elderly acute myeloid leukemia patients: less treatment, better care?

## TL;DR

This study finds that using hypomethylating agents alone provides similar survival outcomes as combining them with venetoclax in elderly AML patients, with less toxicity.

## Contribution

Demonstrates non-inferiority of HMA monotherapy over HMA/VEN combination in elderly AML patients.

## Key findings

- No difference in overall survival between HMA monotherapy and HMA/VEN combination.
- HMA-treated patients with good performance status had longer survival.
- HMA/VEN combination was associated with higher mortality and worse quality of life.

## Abstract

Hypomethylating agents (HMA) alone or in combination with venetoclax (VEN) are a mainstay for disease control in elderly acute myeloid leukemia (AML). We evaluated the non-inferiority of HMA monotherapy compared to HMA/VEN combination in 227 AML patients aged ≥ 75 years receiving HMA or HMA/VEN combination. No difference in overall survival (OS) was observed between the two groups, with HMA monotherapy demonstrating statistical non-inferiority. HMA-treated patients with favorable performance status had longer OS. The HMA/VEN group experienced higher mortality and worse QoL. HMA monotherapy offers comparable survival outcomes to HMA/VEN with reduced toxicity in elderly AML patients.

The online version contains supplementary material available at 10.1007/s00277-026-06737-3.