67 yr old male with pmh of hepatitic C Cirrhosis and AML originally diagnosed in 2006 s/p induction chemotherapy. Did not receive consolidative therapy including BMT per patient. Additional info not available. Now with recurrent AML with complex karyotype [including 8q+, 17q+, +20 with relative 20q- and tetrapoidy] diagnosed 2022. negative for FLT3 and IDH mutations I started Venclexta plus Vidaza. Performance status ECOG 2. Wanted to ask your experience with cirrhotic patients and the regimen. I'm trying to get him with his GI for surveillance scopes and input regarding hep c therapy. Venclexta dose-reduced to 200 mg due to diflucan ppx. Thanks
I have not run into any major issues in patients with cirrhosis who receive HMA plus venetoclax. The typical dose for venetoclax when given with fluconazole is 200 mg daily. If the patient is considered Child-Pugh class C, then the package insert recommends 50% dose reduction, which would be 100 mg for this particular case. The most challenging aspect of this case would be the expected severe thrombocytopenia if there is a potential bleeding source (varices). You should anticipate needing at least 2 cycles to achieve remission with this regimen, since only 40% of treatment naive patients achieved remission after 1 cycle. Overall, the prognosis is poor with the complex karyotype, especially with the tetraploidy.
