“How I treat” a patient with DNMT3A-mutated AML in remission post intensive chemotherapy

The AML Hub was pleased to speak with Cristina Papayannidis, Universitaria di Bologna, Bologna, IT. We asked, How do you treat a patient with DNMT3A-mutated acute myeloid leukemia (AML) in remission post intensive chemotherapy?

Figure 1. Case study presentation: Patient characteristics and treatment history 

AML, acute myeloid leukemia; CR, complete remission; ECOG, Eastern Cooperative Oncology Group; HSCT, hematopoietic stem cell transplantation.

Papayannidis discusses a case of a 67-year-old female with DNMT3A-mutated AML who achieved remission following intensive chemotherapy. Her comorbidities and advanced age make her ineligible for allogenic hematopoietic stem cell transplant (allo-HSCT) and create a need for maintenance therapy options. Papayannidis recalls the key findings from the phase III QUAZAR AML-001 (NCT01757535) study, published by Wei et al.¹ in the New England Journal of Medicine, evaluating oral azacitidine vs placebo in patients with AML ineligible for allo-HSCT. Papayannidis also reviews the post hoc subgroup analysis of this trial presented by Lopes De Menezes² at ASH 2023, which evaluated the efficacy of oral azacitidine in various mutational subgroups, to guide her treatment approach. She concludes that, for patients not proceeding to allo-HSCT after chemotherapy, oral azacitidine is an important treatment option that is effective in all subgroups of AML, in particular in those with DNMT3A and SRSF2 mutations.

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