Venetoclax-based combinations for acute myeloid leukemia: optimizing their use in Latin-America

Objectives: Venetoclax combinations are a new standard for patients with acute myeloid leukemia (AML). We aimed to evaluate the safety and efficacy of these combinations in a period of accelerated approval in Latin-America.Methods: This observational study evaluated adults with acute myeloid leukemia who received venetoclax-based therapy in 11 public or private centers in Mexico and Peru for both newly diagnosed or relapsed and refractory AML.Results: Fifty patients were included; 28 with newly diagnosed (ND) AML and 22 with relapsed/refractory (RR) disease. ND patients were older (64 vs. 40 years; p < 0.001) with a lower functional capacity (ECOG ≥2 64.3% vs 9%; p < 0.001). Venetoclax was frequently combined with azacytidine (60%) and prophylactic azoles (82%) with a median maximum dose of 200 mg (range, 100-600 mg). Hematologic toxicities were common. Complete response rates including patients with incomplete hematopoietic recovery were 78.6% in ND and 45.5% in RR patients, with a median overall survival of 9.6 (95% CI 3.7-15.5) and 8 months (95% CI 4.8-11.2).Discussion: Our study showed a preferred use of venetoclax plus azacytidine over cyatrabine. Patients in the first-line setting were similar to those in the landmark studies, while most patients with relapsed disease had received prior intensive therapies. Responses were favorable, with a median survival in agreement to other reports, albeit shorter than that observed in the randomized phase-3 trials.Conclusion: Venetoclax-based therapy in AML was effective despite dose reductions and prophylactic antifungals in two middle-income countries outside of a clinical trial setting.

[Primary gastric lymphoma: incidence, prognostic factors and effect of treatment with chemotherapy]

This paper deals with the prevalence, clinical features and therapeutic response of 19 patients with primary gastric lymphoma studied and treated at Centro de Hematologia y Medicina Interna de Puebla, Mexico and Instituto Nacional de la Nutricion Salvador Zubiran, Mexico City, Mexico, in a 10 year period (1979-1989). The main findings were as follows: 1) The prevalence of gastric lymphoma has increased in Mexico: Between 1950 and 1980 the prevalence was found at 4.5% of all gastric tumors, whereas between 1980 and 1990 it was found at the 7.6% level (chi square = .0001). 2) The significant prognostic factors for survival were in this series the clinico-pathologic stage and the degree of infiltration of the gastric wall: 80-month disease free survival was 80% and 44% respectively for stages I and III (p less than 0.02); 10-year disease free survival was 100% and 23% respectively for mucosal/submucosal infiltration VS mucosal/serosal infiltration (p less than 0.01). 3) The 10-year disease free survival was 68% for patients treated with chemotherapy and surgery; this figure is similar to those obtained using radiotherapy and surgery, but with a lower relapse rate. Two patients with lymphomatous lesion less than 3 cm. and invading only mucosae/submucosae were treated solely with chemotherapy and both of them remain disease free after 20 months of follow-up.