Maintenance therapy in AML: The past, the present and the future

Am J Hematol. 2019 Nov;94(11):1254-1265. doi: 10.1002/ajh.25620. Epub 2019 Sep 11.

Abstract

Curative treatment in acute myeloid leukemia (AML) depends on successful induction therapy to achieve a complete remission (CR), and subsequent post-remission therapy to prevent relapse. High relapse rates after consolidation therapy and after allogeneic stem cell transplant contribute to suboptimal outcomes in AML patients, and continue to represent a difficult challenge. Effective maintenance therapy could play an important role in prolonging the remission interval in the post-consolidation setting, especially in high risk AML patients. Maintenance treatment approaches based on conventional chemotherapy, immunotherapy, hypomethylating agents, and targeted small molecules have been explored in this setting, but no data so far have been convincing enough to establish this approach as the standard of care. However, ongoing and future studies including novel targeted therapies may demonstrate promising efficacy that could facilitate incorporation of maintenance therapy into clinical practice. In this review we summarize previous and ongoing approaches of maintenance therapy in AML and discuss the most promising strategies.

Publication types

  • Review

MeSH terms

  • Antineoplastic Agents / therapeutic use
  • Clinical Trials as Topic
  • Combined Modality Therapy
  • DNA Methylation / drug effects
  • Disease-Free Survival
  • Drug Resistance, Neoplasm
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Immunotherapy
  • Interferons / therapeutic use
  • Interleukin-2 / therapeutic use
  • Leukemia, Myeloid, Acute / mortality
  • Leukemia, Myeloid, Acute / therapy*
  • Maintenance Chemotherapy*
  • Molecular Targeted Therapy*
  • Multicenter Studies as Topic
  • Neoplasm Proteins / antagonists & inhibitors
  • Neoplasm, Residual
  • Recurrence
  • Remission Induction

Substances

  • Antineoplastic Agents
  • Interleukin-2
  • Neoplasm Proteins
  • Interferons