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We retrospectively analyzed the impact of VEN approval on treatment patterns and outcomes in older AML patients aged 65\u201374\u00a0years unfit for intensive chemotherapy in Japan. Using the Hokkaido Leukemia Net database, we categorized 101 patients into pre-VEN (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200946) and post-VEN (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200955) cohorts, excluding those who had acute promyelocytic leukemia or received intensive chemotherapy. Following VEN approval, VEN\u2009+\u2009azacitidine (AZA) became the most frequently used initial regimen (56%). Despite higher rates of\n                    <jats:italic>TP53<\/jats:italic>\n                    mutations and complex karyotypes (35.5%), VEN\u2009+\u2009AZA achieved comparable response rates (CR\u2009+\u2009CRi: 64.5%) and overall survival (OS, median 11.7\u00a0months) to r7\u2009+\u20093 (CR\u2009+\u2009CRi: 64.5%, median OS: 13.1\u00a0months), and superior outcomes to cytarabine\u2009+\u2009aclarubicin\u2009+\u2009G-CSF (CAG, CR\u2009+\u2009CRi 37.5%, median OS 6.8\u00a0months) or AZA monotherapy (CR\u2009+\u2009CRi 12.5%, median OS 4.5\u00a0months). Early mortality at 60\u00a0days from diagnosis was lower with VEN\u2009+\u2009AZA (3.2%) than with reduced-dose cytarabine plus anthracycline (r7\u2009+\u20093) (12.9%), CAG (26.7%), or AZA monotherapy (18.8%). Our findings demonstrate a substantial shift in real-world treatment practices following VEN approval and suggest that VEN\u2009+\u2009AZA is an effective option for older AML patients with adverse genetic features.\n                  <\/jats:p>","DOI":"10.1007\/s12185-026-04193-3","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T17:33:12Z","timestamp":1773941592000},"page":"167-176","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-world treatment patterns and clinical outcomes in patients with AML from 65 to 74 years unfit for first-line intensive chemotherapy in Japan"],"prefix":"10.1007","volume":"124","author":[{"given":"Fumiaki","family":"Fujii","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9267-2864","authenticated-orcid":false,"given":"Masahiro","family":"Onozawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shota","family":"Yoshida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Miyashita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Hidaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reiki","family":"Ogasawara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mutsumi","family":"Takahata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junichi","family":"Hashiguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shota","family":"Yokoyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Chiba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoyuki","family":"Saga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taku","family":"Shimizu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ikumi","family":"Kasahara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akio","family":"Shigematsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuya","family":"Fujimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Iyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuyuki","family":"Igarashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichi","family":"Ito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihito","family":"Haseyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mizuha","family":"Kosugi-Kanaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Kondo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takanori","family":"Teshima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"issue":"1","key":"4193_CR1","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1186\/s12929-020-00674-7","volume":"27","author":"HA Hou","year":"2020","unstructured":"Hou HA, Tien HF. 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KF has received research funding from Bristol Myers Squibb, Parexel International, Insight Biosciences Japan, Janssen Pharmaceutical, and Mitsubishi Tanabe Pharma. SI has received honoraria from Alexion Pharmaceuticals, Astellas, Nippon Shinyaku, Novartis, Otsuka, Sanofi, SymBio Pharmaceuticals, Asahikasei-pharma, Kyowa Kirin, and Chugai pharmaceutical; received research funding from MSD, Otsuka, JCR pharma, Chugai pharmaceutical, Kyowa Kirin, Novartis. MKK is an employee of AbbVie. TK has received honoraria from Bristol Myers Squibb, Otsuka Pharmaceutical, Novartis, and Pfizer. TT has received honoraria from Astellas, Kyowa Kirin, Novartis Pharma, Bristol Myers Squibb, AstraZeneca, AbbVie, Gilead Sciences, Nippon Shinyaku, Janssen Pharmaceutical; received research funding from LUCA Science, Priothera, PharmaEssentia Japan, AbbVie, IQVIA Services Japan, Kyowa Kirin, CMIC, Chugai Pharmaceutical, Novartis, Janssen, CSL Behring, Gilead Sciences; received educational or unrestricted grants from Kyowa Kirin, Sumitomo Pharma, and Chugai Pharmaceutical. The other authors declare no conflicts of interest. AbbVie funded this study.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}