Revisiting maintenance therapy in acute myeloid leukemia with novel agents.

Overview

PURPOSE OF REVIEW: High relapse rates and therapy-related toxicity contribute to suboptimal outcomes in acute myeloid leukemia (AML) patients attaining a remission following initial induction therapy and postallogeneic stem cell transplant. Maintenance therapy holds the potential for a prolonged remission interval analogue to that seen in other hematologic malignancies. Herein we present and analyze the current data in the field. RECENT FINDINGS: Maintenance treatment approaches utilizing conventional chemotherapy, immunomodulation, hypomethylating agents, targeted small molecules, and tyrosine kinase inhibitors have been explored in this setting. The published data have not yet demonstrated convincing efficacy to merit establishment of this approach as standard of care. The role of hypomethylating agents and novel tyrosine kinase inhibitors is being actively studied in phase II/III trials and may improve patient outcome. SUMMARY: Maintenance therapy has not been shown to improve patient outcome in AML. The results of ongoing and future studies with novel agents may facilitate incorporation of this approach to standard care of AML.