ENABLE: treatment combination including decitabine and venetoclax in acute myeloid leukemia secondary to myeloproliferative neoplasms

Abstract

The management of patients with acute myeloid leukemia (blast phase) secondary to myeloproliferative neoplasms (MPNs) is extremely challenging and the outcome dismal, with a median overall survival of about 3–6months. Effective therapeutic approaches are lacking, especially when intensive strategies followed by allogeneic transplantation are not feasible. The combination of venetoclax and hypomethylating agents has recently been established as standard for newly diagnosed, unfit patients with de novo acute myeloid leukemia, but the application of this therapeutic modality has not been tested prospectively in the specific context of blast-phase MPNs. ENABLE is an open, phase II clinical trial aimed at verifying the efficacy and safety of the combination of venetoclax and decitabine in patients with post-MPN blast phase.

Plain language summary

The evolution into a blast phase represents a dramatic and often fatal event in the disease course of patients affected by myeloproliferative neoplasms. Aside from a minority of patients who can be offered an allogeneic transplant, the median survival from disease evolution is about 3–6months. There is a serious unmet need for clinical trials with innovative approaches for this category of patients. In the ENABLE clinical trial, we aim to verify the efficacy and safety of the combination of venetoclax (a BCL2 inhibitor) and decitabine (a hypomethylating agent) in this disease subset, characterized by a complex dynamic of clonal evolution and a particularly unfavorable prognosis.

Keywords::

• blast phase
• decitabine
• myeloproliferative neoplasms
• secondary acute leukemia
• venetoclax

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.tandfonline.com/doi/suppl/10.2217/fon-2022-0512

Author contributions

F Mannelli and A Vannucchi conceived and designed the research and wrote the manuscript. P Guglielmelli contributed to translational research elaboration and critically reviewed the manuscript. P Fazi, E Crea, A Piciocchi, M Vignetti, S Amadori, F Pane and A Venditti contributed to protocol drafting and critically reviewed the manuscript.

Financial & competing interests disclosure

The ENABLE study is supported by Associazione Italiana per la Ricerca sul Cancro (AIRC) 5×1000 call ‘Metastatic disease: the key unmet need in oncology’ to MYNERVA (MYeloid NEoplasms Research Venture AIRC), project #21267; Cancer Research UK [C355/A26819] and FC AECC and AIRC under the Accelerator Award Program. The drug venetoclax is provided free of cost from AbbVie, while decitabine is used according to approved reimbursement criteria in Italy. A Vannucchi was involved in advisory boards of AbbVie. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

The ENABLE study is supported by Associazione Italiana per la Ricerca sul Cancro (AIRC) 5×1000 call ‘Metastatic disease: the key unmet need in oncology’ to MYNERVA (MYeloid NEoplasms Research Venture AIRC), project #21267; Cancer Research UK [C355/A26819] and FC AECC and AIRC under the Accelerator Award Program. The drug venetoclax is provided free of cost from AbbVie, while decitabine is used according to approved reimbursement criteria in Italy. A Vannucchi was involved in advisory boards of AbbVie. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.