Optimal post-remission consolidation therapy in patients with AML

Acta Haematol. 2023 Nov 26. doi: 10.1159/000535457. Online ahead of print.ABSTRACTBACKGROUND: Despite recent advances, 40-85% of patients with acute myeloid leukemia (AML) achieve complete remission after intensive chemotherapy. However, without optimal treatment after remission, the risk of relapse remains high.SUMMARY: A variable number of consolidation cycles consisting of intermediate doses of cytarabine are the most commonly used regimens in low-intermediate risk AML, while patients at higher risk of relapse should consolidate response by proceeding to HSCT. Different post-consolidation (maintenance therapies) have demonstrated their benefit in prolonging relapse-free survival, and others are still under investigation. Careful consideration should be given to which patients benefit most from each of these interventions, considering that the risk of relapse is dynamic.KEY MESSAGES: Patients consolidated with chemotherapy should receive either 2 courses of HDAC or no more than 3-4 cycles of IDAC with dose reduction in patients over 60 years. Patients with mutated FLT3 AML benefit from post-consolidation maintenance with FLT3-inhibitors and selected patients not fit for adequate consolidation may benefit from CC-468 maintenance. Patients at higher risk of relapse should proceed to allogeneic-SCT as soon as possible, opting for a more intensive conditioning (MAC) in patients younger than 55 years. However, autologous HSCT may still have role in favourable-risk MRD-negative A...
Source: Acta Haematologica - Category: Hematology Authors: Source Type: research