[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-448253-105":3,"detail-sidebar-cat-0-en-105":80,"doc-detail-448253-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","metronomic-low-dose-regimen-of-decitabine-and-venetoclax-is-safe-and-reduces-monocyte-burden-in-chronic-myelomonocytic-leukemia","Metronomic low-dose regimen of decitabine and venetoclax is safe and reduces monocyte burden in chronic myelomonocytic leukemia","","Letter to the editor describing a retrospective cohort study in newly diagnosed chronic myelomonocytic leukemia (CMML) patients treated at Montefiore Einstein Comprehensive Cancer Center with metronomic weekly low-dose decitabine plus venetoclax. Patients received decitabine 0.2 mg/kg subcutaneously and venetoclax 400 mg orally on days 1, 8, 15, and 22 of a 28-day cycle. The study assessed CMML response using 2015 MDS/MPN International Working Group criteria and monitored longitudinal cytopenias, safety, and adverse events, with repeated-measures ANOVA comparing monocyte values.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/research-report/","Research & Report",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/metronomic-low-dose-regimen-of-decitabine-and-venetoclax-is-safe-and-reduces-monocyte-burden-in-chronic-myelomonocytic-leukemia/448253/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/metronomic-low-dose-regimen-of-decitabine-and-venetoclax-is-safe-and-reduces-monocyte-burden-in-chronic-myelomonocytic-leukemia/448253.png","ImageObject",300,407,{"name":42,"@type":43},"Miles","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-04","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":30},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"What treatment regimen was studied for CMML patients?","Question",{"text":62,"@type":63},"Patients received metronomic weekly low-dose decitabine combined with venetoclax. Decitabine was given at 0.2 mg/kg subcutaneously and venetoclax at 400 mg orally on days 1, 8, 15, and 22 of a 28-day cycle.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"Why was the study designed to use a metronomic approach rather than continuous venetoclax exposure?",{"text":67,"@type":63},"The letter explains that continuous venetoclax exposure, per AML labeling, led to 100% grade 3–4 cytopenic adverse events. The metronomic weekly schedule aimed to reduce toxicity while maintaining potential efficacy.",{"name":69,"@type":60,"acceptedAnswer":70},"How were outcomes assessed in the retrospective cohort?",{"text":71,"@type":63},"The primary objective was to assess CMML response using the 2015 MDS/MPN International Working Group response criteria. Secondarily, the study evaluated changes in cytopenias over time and tracked mortality and length of therapy alongside hospitalizations and adverse events.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},448253,1790794525,{"code":4,"msg":81,"data":82},"success",[83,87,91,95,100,105,110,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":88,"show_sort_weight":89,"slug":90},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":92,"show_sort_weight":93,"slug":94},"Exam",70,"exam",{"id":96,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},5,"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":107,"show_sort_weight":108,"slug":109},7,"Healthcare",40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":112,"slug":113},8,30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":96,"slug":129},19,"General","general",{"code":4,"msg":81,"data":131},{"doc_id":78,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":111,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":30,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":96,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144},13056703019404,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","LETTER TO THE EDITOR  \nMetronomic low-dose regimen of decitabine and venetoclax is safe and reduces monocyte burden in chronic myelomonocytic leukemia  \nChronic myelomonocytic leukemia (CMML) is a myeloid neoplasm with features both of myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPN), that has a high propensity to transform into acute myeloid leukemia (AML) . Allogeneic stem cell transplant (alloSCT) is the only available cure but is reserved for younger fit patients. Hypomethylating agents (HMA) are currently the only Food and Drug Administration (FDA)-approved therapies for CMML based on trials that predominantly enrolled patients with MDS and only a fraction with CMML. In fact, the only phase III trial that exclusively enrolled CMML patients and compared HMA to hydroxyurea did not show an event-free or overall survival (OS) benefit for HMA over hydroxyurea.1,2 This was despite the higher response rate in the HMA arm, as this was offset by increased toxicity related to infections from myelosuppression. Optimizing the dosing schedule of HMA therapy in CMML may overcome toxicity, thereby enhancing the efficacy and survival benefits.  \nVenetoclax (Ven) is a BCL-2 inhibitor that, when combined with HMA, is the current standard of care for elderly or frail patients with AML3 unfit for “intensive chemotherapy.” Similar to AML, the addition of Ven to HMA in MDS4 has been challenging due to myelosuppression with the current practice of prolonged and continuous Ven exposure. In two previous studies decitabine, administered by a minimum biologically effective dose (MBD) to produce HMA effects (“low-dose decitabine”) administered once a week (“metronomic”) combined with Ven, also given weekly, was shown to be effective and well tolerated in elderly and frail patients with AML and MDS, including heavily pre-treated patients with poor bone marrow (BM) reserves.5,6 The addition of Ven to HMA therapy has been tried in CMML but is limited to retrospective experiences. Using continuous Ven, per the current FDA label in AML, has resulted in 100% of patients having grade 3-4 cytopenic adverse events.7 In addition, outcomes do not appear improved over single agent HMA despite decreases in dosing schedules to mitigate toxicities.8 Here, in an effort to rationalize the HMA/Ven combination towards decreasing toxicities and risks while maintaining potential efficacy benefits, we report the results of a retrospective cohort study of newly diagnosed CMML patients treated with metronomic weekly low-dose decitabine and Ven at Montefiore Einstein Comprehensive Cancer Center. Eligible patients had histologically confirmed CMML by World Health Organization (WHO) criteria. Patients re-  \nceived decitabine 0.2 mg/kg subcutaneous injection and Ven 400 mg by mouth on days 1, 8, 15 and 22 of a 28-day cycle. Full methods have previously been reported.6 The study was designed according to Good Clinical Practice Guidelines and the Declaration of Helsinki.  \nThe primary objective was to assess CMML response criteria, defined by the 2015 MDS/MPN International Working Group.9 Secondarily, we assessed changes in cytopenias over time. Mortality and length of therapy are also re  \nTable 1. Baseline characteristics.  \n\n| Baseline characteristics | Values |\n| --- | --- |\n| Age, years, median (range) | 73 (65-81) |\n| Male, N (%) | 7 (88) |\n| WBC x109/L, median | 14 |\n| ANC x109/L, median (range) | 0.66 (0 .5-20) |\n| Monocytes x109/L, median | 6.15 |\n| Hb, g/dL, median (range) | 11.2 (6 .9-12.8) |\n| Hb \u003C10 g/dL, N (%) | 4 (50) |\n| Platelets x109/L, median (range) | 80 (36-301) |\n| Bone marrow blasts >5%, N (%) | 3 (38) |\n| Transfusion dependence, N (%) | 4 (50) |\n| CPSS-Mol low risk, N (%) | 3 (38) |\n| CPSS-Mol intermediate risk, N (%) | 4 (50) |\n| CPSS-Mol high risk, N (%) | 1 (12) |\n| Patient | Indication for treatment |\n| 1 | Thrombocytopenia transfusiondependent |\n| 2 | Anemia, thrombocytopenia |\n| 3 | Rising KRAS mutation |\n| 4 | Anemia, moderate","cbCairhrdIJapfXc","https://ap.wps.com/l/cbCairhrdIJapfXc","pdf",6353344,"English","# Study background and rationale\n## Prior HMA and venetoclax limitations in CMML\n# Treatment regimen and study design\n## Eligibility criteria and dosing schedule\n## Primary and secondary objectives\n# Baseline characteristics\n## Patient demographics and prognostic risk\n## Mutation profile\n# Results and safety signals\n## Changes in blood counts over time\n## Hospitalizations and adverse events","[{\"question\":\"What treatment regimen was studied for CMML patients?\",\"answer\":\"Patients received metronomic weekly low-dose decitabine combined with venetoclax. Decitabine was given at 0.2 mg/kg subcutaneously and venetoclax at 400 mg orally on days 1, 8, 15, and 22 of a 28-day cycle.\"},{\"question\":\"Why was the study designed to use a metronomic approach rather than continuous venetoclax exposure?\",\"answer\":\"The letter explains that continuous venetoclax exposure, per AML labeling, led to 100% grade 3–4 cytopenic adverse events. The metronomic weekly schedule aimed to reduce toxicity while maintaining potential efficacy.\"},{\"question\":\"How were outcomes assessed in the retrospective cohort?\",\"answer\":\"The primary objective was to assess CMML response using the 2015 MDS/MPN International Working Group response criteria. Secondarily, the study evaluated changes in cytopenias over time and tracked mortality and length of therapy alongside hospitalizations and adverse events.\"}]","Metronomic low-dose regimen of decitabine and venetoclax is safe and reduces monocyte burden in chronic myelomonocytic leukemia | PDF",1790726287,13]