Introduction: Myeloid sarcoma (MS) is a rare malignant myeloid tumor of the blood system that can affect any part of the body and often occurs in conjunction with acute myeloid leukemia. In the 2022 WHO classification, myeloid sarcoma is recognized as an independent entity, with a significant heterogeneity in overall prognosis and a short survival time. Currently, there is no consensus on induction regimen. Previous studies indicate that intensified cytarabine therapy or Venetoclax with hypomethylation agents has yielded not ideal responses. Using venetoclax combined with intensive therapy might synergistically enhance the anti-sarcoma effect. Considering that liposomal mitoxantrone has strong penetrability to extramedullary sites; therefore, we designed the triple regimen of Venetoclax, Mitoxantrone Liposome and Cytarabine (VMA) for the newly diagnosed myeloid sarcoma patients at the First Affiliated Hospital of Zhejiang University, aiming to evaluate the efficacy and safety.
Methods: Patients received the following VMA regimen: Venetoclax 100mg on day 1, 200mg on day 2, and 400mg on days 3 to 7; Mitoxantrone Liposome 30mg on day 1; Cytarabine 100mg/m2 on days 1-7. Each treatment cycle lasted for 28 days. Patients who achieved CR, CRh, or CRi, as per the center's treatment guidelines, were eligible for transplantation at any time point. The primary objective being to evaluate the proportion of patients achieving complete remission (CR) after two cycles. The evaluation of residual lesions through PET-CT or enhanced CT.
Results: A total of 3 patients were treated with VMA regimen for up to four courses. After 1-2 cycles, the MS mass notably reduced. Currently, 2 out of 3 patients have achieved complete remission after two cycles. A 27-year-old male patient had an anterior-mediastinal involvement (5.1*2.9 cm). After 1 cycle of VMA regimen, the anterior mediastinal mass dramatically decreased to 2.5*0.1 cm. He achieved CR after two cycles of VMA regimen and underwent an Allo-SCT. A 42-year-old male with a 3.9*2.2 cm urinary issue achieved complete remission after four VMA regimen cycles but declined transplantation and is under monitoring. A 44-year-old female had a gastic involvement (1.9*1.2cm). After 1 cycle of VMA regimen, his gastric wall thickening was immeasurable.
The most frequently reported adverse events of Grade 2-3 included anemia, nausea, fatigue, anorexia, and hyponatremia. All adverse events could be managed and improved through dose adjustments and supportive treatment.
Conclusions: The initial observations of VMA regimen have been found to be safe and effective, with encouraging complete response rates in newly diagnosed MS patients. Further correlative trials and analysis are currently underway to thoroughly observe the efficacy and safety of the VMA regimen.
No relevant conflicts of interest to declare.
Liposomal Mitoxantrone has strong penetrability to extramedullary sites.
This feature is available to Subscribers Only
Sign In or Create an Account Close Modal