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AML in Unfit Patient — RACP Adult Medicine MCQ

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ModerateHaematologyAML in Unfit PatientRACP Adult Medicine

A 78-year-old man with multiple comorbidities (CKD stage 4, NYHA class III heart failure) is diagnosed with AML. Bone marrow shows 40% blasts. He is not fit for intensive chemotherapy. What is the most appropriate initial treatment?

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Correct answer: A — Venetoclax plus azacitidine

For older or unfit patients with AML, venetoclax plus azacitidine is now standard of care (VIALE-A trial: significant OS benefit over azacitidine alone). This lower-intensity regimen achieves CR rates of ~65% with manageable toxicity. Dose adjustments are needed for azole antifungals (CYP3A4 interaction with venetoclax).

Reference: ALLG – 2024 – AML Treatment; ELN 2022; VIALE-A Trial