75 year old with acute myloid leukemia. Is vyxeous a good idea?

Hello,
I am 74 years old and was diagnosed with MDS in 2024 after a bone marrow extract and because my blast numbers weren't that high and my white, red cells and platelets were low but acceptable I was on watch and wait for 2 years. In June of this year (2026), I had a bone marrow extract which showed the blasts were now at the Acute Myeloid Leukemia stage and my hematologist put me on the Azacitidine injections (7 days a month) and Venclexta pills (14 days per month) treatment. So far I have had 2 rounds of this treatment (June and August). My July treatment was delayed because my white cells, and platelets dropped too low. My blood test results by the beginning of August showed increase in all my affected cells and the bone marrow extract done following the first treatment showed blasts had gone back to normal. Since my August treatment my hemaglobin has gone up steadily but my white cells and platelets have dropped again. Platelets are very low at 34 (Canadian numbers) and had been as high at 300+ after the July treatment. In between, I have had 2 blood transfusions for red cells as they dropped to 75 and 77 respectively. Now they are at 106. I am to start treatment again Sept. 3 but not sure if it will be delayed due to low platelets. I have a blood test weekly. I did not have any adverse reactions to the Azacitidine except for redness and lumps at the injection sites right afterward. The adverse affect I had from Venclexta was constipation. Everyone will react differently to these drugs. I was not offered a bone marrow transplant as I was told my cells were too low and they had to be higher if I was to have one (also my age). Hope this information helps.

Hi @joey176 This diagnosis for your mom must feel overwhelming to both of you, with so much information and decision making needing to happen. Well, you came to the right place. We’ve got your back here in Connect. There’s a great group of people here who have had AML at our later stage of life.

Some of us, like myself have received the more aggressive chemo treatments requiring hospitalization and a bone marrow transplant. I was 65 at the time. Then there is a growing number for whom the drugs Vidaza(Azacitidine) and Venetoclax, or Dacogen/Venetoclax and a new one, Inqovi, have been shown to be quite successful in controlling the cancer cells, with many people reaching remission. These are lower intensity drugs which are much better tolerated by older patients. Certainly, there are still some side effects but generally much less pronounced that standard chemo.

Considering your mom has stage 4 kidney disease, that would be an eye brow raiser for a bone marrow transplant team. Both the pre-conditioning chemo and the transplant itself with donor cells can be challenging for older patients. As we age, our bodies don’t tolerate or metabolize chemicals as quickly which can cause problems with the organs.

While there is no actual cutoff age for a bone marrow transplant, at 75, your mom’s eligibility wouldn’t be guaranteed. From my experience as the mentor in the BMT/SCT support groups, at 75, many hospitals wouldn’t do a bone marrow transplant unless the patient was exceptionally healthy prior to AML and was willing to accept the risk vs reward.

I’m just giving it to you straight as a 72 year old woman who had a bone marrow (stem cell) transplant 7 years ago. It was an amazing 2nd chance at life and I would do it again in a heartbeat. But at 75, I’d have to really consider my options. Knowing what I do with the wonderful members who share their stories of taking Vidaza and Venetoclax or Dacogen and Venetoclax and achieving remission or at least controlling the progression of their AML, I’d be leaning to the less draconian options of the meds vs the transplant at 75.

Sharing some success stories with you:
AML Age 78 (No transplant)
https://connect.mayoclinic.org/discussion/aml-age-78-taking-decetabine-venetoclax-no-transplant/
With members @lindagi @sonieaml

I did a quick search for you by typing in Vidaza and Venetoclax in the upper search bar. Here are the results of all the discussions involving those drugs. You scroll through and pop into any discussion to ask questions. https://connect.mayoclinic.org/search/

I’m here, along with fellow AML members to help you and your mom through this. Whatever you decide to do, this is a good place for moral support and a sounding board. You mentioned not knowing the mutations behind her AML yet. The mutations can help direct the treatment. Will you please let me know what you find out?

@joey176, I add my welcome and hope you saw the helpful and informed reply from @loribmt.

I agree with Lori that health status is an important criteria that the doctors consider when recommending treatment. The chronic kidney disease will be a factor in the treatment recommendations.

Have you considered getting a second opinion?

Hi @cathycarol, I wanted to welcome you to Mayo Connect and also thank you for sharing your story of having MDS which was moving towards AML. The two medications you’re taking, Azacitidine (Vidaza) and Venetoclax have been game changers in the treatment for AML in older patients where aggressive chemo isn’t tolerated as well. So it was really helpful and timely in your reply to @joey176 with their questions about treatments for AML. We also have several members in the forum who have very positive outcomes using the same treatments.

Azacitidine is geared towards eliminating quickly dividing cancer cells. Unfortunately it can’t discriminate between other rapidly dividing cells, such as blood cells. So it’s not uncommon to have blood counts drop lower mid cycle. Sometimes it can take longer to rebound after successive treatments. But usually the body recovers in time for the next round. Looks like you’re getting a little break before the next one.
Wishing you continued success with your treatments. Seeing that your blast count dropped to normal after the first treatment is very encouraging. Will you please keep me updated?

My father was 76 when he was diagnosed with AML. The VA would not do the BMT, due to his age, but would refer him elsewhere for it. He opted for option two given to your mother and is still in “remission”, as he’s set to turn 79 next month! He has tolerated the treatment well other than it affecting his bone density. Praying for you and your mother!