CPX-351 versus venetoclax plus hypomethylating agents for newly diagnosed acute myeloid leukemia: A systematic review...

Acute myeloid leukemia (AML) predominantly affects older adults, with median age at diagnosis being 68-70 years. Selecting an appropriate regimen is important for older patients. CPX-351 demonstrated superior overall survival (OS) compared to 7 + 3 chemotherapy, while venetoclax and azacitidine significantly improved OS and composite remission rate compared to azacitidine alone. However, the optimal regimen in real-world practice remains uncertain. We performed a systematic review and meta-analysis comparing CPX-351 and the combination of venetoclax and hypomethylating agents (Ven/HMA) in newly diagnosed AML. We systematically searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials from inception to January 2026. Eleven retrospective studies comprising 1852 patients comparing CPX-351 and Ven/HMA were included. The weighted mean of median age was 63.5 years in the CPX-351 cohort and 73 years in the Ven/HMA cohort. CPX-351 did not significantly improve OS (hazard ratio [HR] 0.89; 95 % CI 0.76-1.04; p = 0.1486) with median OS being 13.1 months versus 11.6 months in Ven/HMA cohort. There were no differences in the rates of composite remission rate (48.3 % vs 48.4 %; odds ratio [OR] 0.83; 95 % CI 0.58-1.18; p = 0.295), minimal residual disease negative remission (13.5 % vs 33.9 %; OR 0.61; 95 % CI 0.25-1.49; p = 0.281), 30-day mortality, and 60-day mortality. In conclusion, CPX-351 did not demonstrate superiority over Ven/HMA in composite remission rate and OS. Both regimens remain reasonable therapeutic options for older, newly diagnosed AML patients, and prospective comparative studies are needed to better guide treatment selection.