“How I treat” a patient with AML in remission after intensive chemotherapy not proceeding to HSCT

The AML Hub was pleased to speak with Eytan Stein, Memorial Sloan Kettering Cancer Center, New York, US. We asked, How do you treat a patient with acute myeloid leukemia (AML) in remission after intensive chemotherapy not proceeding to hematopoietic stem cell transplantation (HSCT)?

Stein begins by discussing the role of maintenance therapy and its application, particularly in patients who have received intensive induction chemotherapy but are ineligible for HSCT. Citing results from the QUAZAR AML-001 trial, he shares his rationale for using oral azacitidine maintenance in routine clinical practice in patients with intermediate or adverse-risk cytogenetics who are ineligible for HSCT due to factors such as comorbidities. He further explains how oral azacitidine could benefit patients across subgroups, including those who are minimal residual disease (MRD) positive after induction or consolidation, or those who were unable to complete consolidation therapy. Stein highlights maintenance approaches for FLT3-mutated AML, with agents including quizartinib, midostaurin, and gilteritinib, and discusses emerging options such as menin inhibitors for NPM1-mutated and KMT2A-rearranged AML. He stresses the need to carefully assess whether maintenance therapy is necessary, as patients with favorable risk AML may be at risk of overtreatment, and emphasizes the role of MRD monitoring in guiding treatment decisions.