Editor's Note: Yanzhao brings together talented individuals while remaining true to its original mission for 14 years. On August 21, 2026, the 14th Lu Daopei Hematology Forum grandly opened at Hebei Yanda Lu Daopei Hospital. Building on 14 years of academic development, this year's conference focused on cutting-edge topics including hematopoietic stem cell transplantation, cellular immunotherapy, and precision diagnosis and treatment of hematologic diseases. Experts and scholars from across the field of hematology gathered to discuss advances in the discipline, making the conference an important academic platform for promoting progress in the diagnosis and treatment of hematologic diseases in China. During the conference, Oncology Frontier – Hematology Frontier invited Dr. Jiujiang He of Hebei Yanda Lu Daopei Hospital for an exclusive interview. He shared his professional insights on the therapeutic role of venetoclax in acute myeloid leukemia (AML), challenges in real-world clinical practice, and future directions, providing perspectives and references for the standardized diagnosis and treatment of AML.Oncology Frontier – Hematology Frontier: Could you introduce the role of venetoclax in AML treatment? Which patients are most suitable for venetoclax?
Dr. Jiujiang He: With the advent of the era of targeted therapy, venetoclax-based combination regimens have reshaped the first-line treatment landscape for patients with AML who are unable to tolerate intensive induction chemotherapy and have now become the standard first-line treatment for this population. Previously, treatment options were very limited for older, frail AML patients and those with underlying comorbidities, and their overall prognosis was poor. Venetoclax combined with hypomethylating agents can significantly improve patients’ response rates, prolong overall survival, and improve their quality of life. At the same time, a large number of real-world studies are continuously expanding the application of venetoclax, with ongoing exploration in patients eligible for intensive chemotherapy and those with relapsed/refractory disease. Overall, venetoclax has become a cornerstone drug in the treatment of AML.
In terms of eligible populations, it mainly covers three groups:
The first group comprises adults with newly diagnosed AML who are unable to tolerate intensive chemotherapy, particularly older patients and those with poor organ function or poor performance status;
The second group comprises patients harboring mutations such as NPM1, IDH1, and IDH2, who are expected to achieve favorable therapeutic outcomes and may also receive venetoclax-based regimens;
The third group comprises patients with relapsed/refractory disease who have not previously received venetoclax and may receive appropriate treatment following assessment.
In clinical practice, treatment decisions should ultimately be based on a comprehensive assessment of the patient’s comorbidities, treatment goals, and other factors to develop an individualized treatment plan.
Oncology Frontier – Hematology Frontier: What challenges does the use of venetoclax face in real-world clinical practice? What guidance have expert recommendations provided?
Dr. Jiujiang He: In the real-world setting, there are three major challenges in the clinical application of venetoclax:
The first is that the selection of combination regimens is not yet standardized. Although there is already a clear consensus regarding first-line treatment, no unified standard has yet been established for the optimal combinations in patients with relapsed/refractory disease, those with special complications, or those harboring different gene mutations. There are considerable differences among centers in terms of drug dosage, treatment duration, and consolidation and maintenance strategies, making this an area that urgently requires further exploration.
The second is adverse event management. The main issue is prolonged bone marrow suppression, which consequently increases the risks of infection and bleeding. At the same time, blood cell recovery may be slow, requiring careful consideration of when and how to restart treatment. In addition, treatment-related tumor lysis syndrome, gastrointestinal reactions, hepatic and renal dysfunction, and the resulting need for treatment adjustments are also challenges that need to be addressed in clinical practice.
The third is drug resistance. Primary resistance or resistance after relapse is not uncommon in clinical practice, and the mechanisms of resistance are complex. Once resistance develops, there is currently no standardized salvage treatment regimen.
In response to these challenges, relevant expert recommendations have also provided practical guidance. First, different combination regimens should be recommended according to patient stratification, with standardized principles for treatment duration and dose adjustment. Second, standards should be established for the prevention and management of bone marrow suppression and tumor lysis syndrome, with standardized procedures for treatment interruption, dose reduction, and treatment reinitiation to balance efficacy and safety. Third, available treatment pathways after resistance should be clarified. Repeat testing for relevant genetic alterations is recommended after resistance to facilitate individualized salvage treatment, while measurable residual disease (MRD) monitoring should be emphasized to improve the ability to predict relapse.
Oncology Frontier – Hematology Frontier: What are your expectations for the future application of venetoclax in AML? Will combination treatment strategies and post-resistance management be the key areas of focus in the future?
Dr. Jiujiang He: The prospects for venetoclax in AML are very broad, and optimization of combination regimens and post-resistance management will be two major areas of future exploration.
Regarding combination strategies, treatment options will no longer be limited to the classic combination of venetoclax and hypomethylating agents. Combining venetoclax with more novel targeted agents and immunotherapeutic agents may further deepen responses and increase MRD negativity rates, helping more patients successfully proceed to transplantation. Its application will also expand into additional settings, including frontline treatment for patients eligible for chemotherapy and maintenance treatment after remission. Exploration of predictive biomarkers will also help achieve more precise treatment stratification.
In terms of resistance management, patients with venetoclax resistance generally have poor outcomes. Future efforts should focus on further elucidating the mechanisms of resistance, developing next-generation drugs capable of overcoming resistance, establishing standardized resistance-management pathways, and exploring early-warning monitoring strategies for relapse.
In addition, individualized dosing strategies for older patients, accumulation of long-term real-world follow-up data, and comprehensive management of patients’ quality of life throughout the treatment course are also important areas worthy of attention. I believe that with the accumulation of more evidence-based data and continuous updates to treatment consensus, the clinical application of venetoclax will become increasingly standardized, ultimately benefiting more patients with AML.
Expert Profile
Jiujiang He
Attending Physician, Department of Hematology, Hebei Yanda Lu Daopei Hospital
Dr. Jiujiang He has been engaged in the diagnosis and treatment of hematologic diseases and CAR-T therapy.
He has systematic diagnostic and treatment strategies for various anemic disorders and complex conditions such as unexplained bleeding, fever, bone pain, and lymphadenopathy.
He utilizes bone marrow morphology, immunology, cytogenetics, and molecular biology examinations to evaluate hematologic malignancies and develop individualized treatment strategies.
He has participated in clinical research on CAR-T cell therapy for refractory/relapsed leukemia at the hospital, as well as several other clinical trials.
