73M, AML M2, adverse risk, not transplant-eligible. Two cycles of azacitidine + venetoclax:
- Cycle 1 (April): aza 130 mg SC d1–8 + ven 100 mg (14 Days) → blasts 23%
- Cycle 2 (June): aza 130 mg SC d1–7 + ven 100 mg (21 Days) → blasts 0%, CR
Cycle 2 was rough. He spent about ten weeks with platelets around 2,000, four transfusions that produced no increment at all, a GI bleed, and three hospital admissions. He was very weak through most of it.
His counts came back on their own over the last three weeks — platelets 51k, Hb 10.1, blasts still 0%. He’s eating properly again and asking when he can travel.
His hematologist now proposes a third cycle with azacitidine alone, no venetoclax. She was straightforward with us: it doesn’t guarantee anything, but without it relapse is likely. She’s leaving the decision to us.
What I keep coming back to: at diagnosis we were told there wasn’t much hope. Now there is some, and the answer is another cycle. I don’t want him to go through one just because it’s the standard next step on a list. And I don’t know where that list ends — do we keep going until his marrow stops tolerating the drugs?
What I’d like to hear from you please:
Did anyone here stop treatment after reaching Remission on aza+ven? How long did the remission hold, and would you make the same call again?
And if you switched to azacitidine alone : was it genuinely easier on the marrow, or did the cytopenias come back anyway?
Thanks, any experience helps.