Fixed-duration cytarabine consolidation improves relapse-free survival over indefinite AZA–VEN in younger AML

To the Editor,The treatment of newly diagnosed Acute Myeloid Leukaemia (ND-AML) requires a personalised approach based on age, comorbidities, and functional status of a patient.The azacitidine-venetoclax (Aza-Ven) regimen, though initially approved for elderly or unfit patients, is now increasingly used in younger adults (<65 years) who are not suitable for intensive chemotherapy.Real-world evidence from the UK NHS reports that 28-35% of patients receiving Aza-Ven were under 65 years old [1], while other studies [2] report similar trends, with median ages between 45 and 55 years [3][4][5].Although Aza-Ven achieves remission rates of 60-70%, long-term follow-up shows that the median relapse-free survival(RFS) remains only 10-12 months [6].Long-term treatment also poses several challenges, like severe (grade 3-4) myelosuppression, frequent dose interruptions, treatment discontinuation, and the development of drug resistance with continuous exposure [7][8][9].Given these limitations, fixed-duration consolidation with high-dose or intermediate-dose cytarabine (HiDAC/IDAC) may offer a safer and more durable alternative for younger AML patients achieving remission with Aza-Ven.This study compares post-remission outcomes of timelimited HiDAC/IDAC consolidation versus continuous Aza-Ven in patients <65 years using real-world data.This was a single-centre medical record review that included patients younger than 65 years with ND-AML.Patients who achieved complete remission (CR) or CR with incomplete haematologic recovery (CRi) after induction with Aza-Ven between June 2022 and June 2025 were included.Patients with secondary AML, mixed-phenotype leukaemia, or those who proceeded directly to allogeneic stem cell transplantation (allo-HSCT) after remission induction were excluded.Among patients in remission, those who did not undergo immediate allo-HSCT or those with favourable risk cytogenetics based on the ELN 2022 classification received one of two post-remission strategies [1] continuation of Aza-Ven until disease progression/intolerance, or [2] three cycles of intermediate/high-dose cytarabine (IDAC/HiDAC; cumulative dose 12-18 g/m) with or without venetoclax (100 mg for 7 days) followed by 12 months of oral azacitidine maintenance (300 mg once daily for 14 days of each 28-day cycle).The decision between Aza-Ven continuation and cytarabine-based consolidation was individualised, considering patient preferences (continuous therapy versus fixed-duration treatment) and the financial feasibility of prolonged venetoclax use.During the study period, 24 patients received cytarabine-based consolidation.Of these, the first 13 received 3 cycles of HiDAC/IDAC alone, while the subsequent 11 patients also received venetoclax (100 mg daily for 7 days with