Post-Induction Treatment for Acute Myeloid Leukemia: Something Change?

Curr Oncol Rep. 2021 Jul 16;23(9):109. doi: 10.1007/s11912-021-01092-0.

Abstract

Purpose of review: Until recently, improvement in terms of survival for patients with acute myeloid leukemia (AML) was achieved mostly in younger patients with dose intensification of conventional chemotherapy and a broadening use of allogeneic hematopoietic cell transplantation (allo-HCT) whereas the results remained dismal and very stable in patients older than 60 years. The current review highlights the recent developments in standard intensive post-remission chemotherapy, evidence for the use of recently approved agents, and discusses the relevance of measurable residual disease (MRD) measurement in treatment adaptation.

Recent findings: Current approvals of midostaurin, venetoclax, gemtuzumab ozogamicin, VYXEOS, ivosidenib, enasidenib, glasdegib, and CC-486 have changed the structure, aim, and schedule of consolidation therapy, and new, well-tolerated agents are being evaluated as maintenance therapies. Furthermore, MRD assessment has been implemented to guide the duration and type of consolidation and maintenance therapy as well as indicate the optimal timing of allo-HCT. Novel therapies have changed the structure and perspective of post-remission therapy in AML for both young and elderly patients. In addition, MRD assessment could guide the type, duration, and intensity of consolidation and maintenance therapy.

Keywords: Acute myeloid leukemia; CC-486; Consolidation therapy; Enasidenib; Gemtuzumab ozogamicin; Glasdegib; High-dose cytarabine; Ivosidenib; Midostaurin; VYXEOS; Venetoclax.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Antimetabolites, Antineoplastic / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cytarabine / therapeutic use*
  • Female
  • Hematopoietic Stem Cell Transplantation / methods*
  • Humans
  • Leukemia, Myeloid / therapy*
  • Male
  • Middle Aged
  • Neoplasm, Residual / diagnosis
  • Neoplasm, Residual / drug therapy*
  • Remission Induction
  • Survival Analysis
  • Transplantation, Homologous

Substances

  • Antimetabolites, Antineoplastic
  • Cytarabine