# Treatment of Acute Myeloid Leukemia in Elderly Patients With Azacitidine–Venetoclax Combination in Developing Countries: A Single-Center Experience

## TL;DR

This study shows that azacitidine-venetoclax is effective for elderly AML patients in Morocco, with a 25-month median survival, but highlights challenges with toxicity and drug cost.

## Contribution

Provides real-world evidence of AZA-VEN effectiveness and safety in elderly AML patients from a North African setting.

## Key findings

- Four out of eight patients achieved complete remission after the first AZA-VEN cycle.
- Median survival was 25 months, with four patients alive at two years.
- Grade 3-4 hematologic toxicities and infectious complications were common.

## Abstract

Background and objectives: Acute myeloid leukemia (AML) predominantly affects elderly patients and is associated with a poor prognosis. Therapeutic options remain limited for patients who are ineligible for intensive chemotherapy. Real-world data on the use of azacitidine-venetoclax (AZA-VEN) in North African populations are scarce. This study aimed to assess the effectiveness, composite complete remission rates, and safety profile of AZA-VEN in elderly AML patients treated at a Moroccan center.

Materials and methods: We conducted a retrospective study including patients aged ≥60 years who received AZA-VEN between July 2021 and August 2024 at the Military Hospital Ibn Sina in Marrakech. VEN was administered with a ramp-up protocol, combined with AZA and prophylactic voriconazole. Treatment response was assessed after the first cycle using bone marrow aspiration and blood counts. Overall survival (OS) was estimated using Kaplan-Meier curves.

Results: Eight patients were included, with a median age of 67 years and a male predominance. Seven patients had comorbidities. Four patients achieved complete remission (CR) after the first cycle, while two showed no response. Four patients experienced relapse or disease progression during follow-up. Grade 3-4 hematologic toxicities were frequent: neutropenia in all eight patients, anemia in seven patients, and thrombocytopenia in seven patients. All patients developed infectious complications. Median follow-up was 17 months, with a median survival of 25 months. Four out of eight patients were alive at two years.

Conclusions: Our single-center experience confirms that AZA-VEN is an effective and feasible therapeutic option for elderly AML patients, with a median survival of 25 months. Hematologic and infectious toxicities remain major challenges. In a North African context, limited access to VEN due to its cost can be partially mitigated through dose adjustments with azole antifungals. Further prospective multicenter studies are warranted.