New Protocol: Cytarabine – MitoXANtrone – Venetoclax for Rel/Ref AML

The RELAX trial demonstrated that the combination of venetoclax with high-dose cytarabine and mitoxantrone is effective and safe for treating relapsed or refractory acute myeloid leukaemia. The treatment achieved a composite complete remission rate of 75%, and showed a favorable safety profile with potentially manageable adverse effects. This regimen may serve as a bridge to allogeneic transplantation for medically fit patients.

  • Study

    Multicentre, open-label, single-arm, phase 1/2 trial [RELAX]
    Relapsed or refractory acute myeloid leukaemia, aged 18-75
    Venetoclax 400 mg daily (days 1-14), mitoxantrone 10 mg/m² (days 5-7), cytarabine dose escalation



  • Efficacy

    Composite complete remission: 75%
    12-month RFS: 66%
    24-month RFS: 58%
    12-month OS: 65%
    24-month OS: 56%



  • Safety

    Grade >=3 AEs: febrile neutropenia (53%), pneumonia (13%), sepsis (13%)
    Serious AEs: sepsis (n=6), pneumonia (n=2)
    Potential treatment-related deaths: 4 (7%), including sepsis (3) and pneumonia (1)


  • Lancet Haematol 2026;13:e157-68

    Ruhnke L, Schliemann C, Mikesch JH Venetoclax plus high-dose cytarabine and mitoxantrone as salvage treatment for relapsed or refractory acute myeloid leukaemia (RELAX): a multicentre, single-arm, phase 1/2 trial

    http://doi.org/10.1016/S2352-3026(25)00358-8

    Reviewed by Ulas D. Bayraktar, MD on Mar 12, 2026

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