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Azacitidine + lenalidomide + venetoclax is a triplet combination therapy being investigated for the treatment of myeloid malignancies, specifically acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). This regimen, often referred to as the ALV regimen in clinical studies led by the Army Medical Center of PLA, combines three distinct mechanisms of action to overcome treatment resistance. Azacitidine is a hypomethylating agent that inhibits DNA methyltransferase, leading to the reactivation of tumor suppressor genes. Lenalidomide is an immunomodulatory drug that targets the cereblon E3 ubiquitin ligase complex, inducing the degradation of specific transcription factors and enhancing immune-mediated anti-tumor activity. Venetoclax is a selective BCL-2 inhibitor that triggers apoptosis by neutralizing anti-apoptotic proteins. The combination is designed to provide a synergistic effect, particularly for older patients or those with relapsed/refractory disease who are ineligible for intensive induction chemotherapy.
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