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“How I treat” using maintenance approaches in patients with AML in clinical practice
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A “how I treat” case series published in Blood by Roboz et al.1 discussed different clinical scenarios involving the use of maintenance treatments in patients with AML. |
| Key learnings |
| Case 1: A 64-year-old male with adverse-risk AML (ASXL1 and RUNX1 mutations) achieved remission after induction with idarubicin and cytarabine, but remained MRD+ by flow cytometry even after consolidation and could not undergo allo-HSCT due to his clinical condition. Treatment with oral azacitidine led to MRD− CR by Cycle 3. However, given his unfavorable risk profile, long-term remission with oral azacitidine was unlikely, so he subsequently underwent allo-HSCT. |
| Case 2: A fit 54-year-old female with NPM1 and SRSF2 co-mutated AML achieved MRD−remission after FLAG-Ida plus GO induction therapy. Despite eligibility, she was keen to avoid allo-HSCT. Consequently, she was treated with two cycles of high-dose cytarabine consolidation, followed by maintenance with oral azacitidine. |
| Case 3: A fit 45-year-old male with FLT3-ITD and IDH1-mutated AML underwent induction with 7+3 and gilteritinib, followed by consolidation with high-dose cytarabine and gilteritinib, but remained MRD+. He subsequently underwent allo-HSCT and was placed on gilteritinib maintenance. |
| Case 4: A 76-year-old female with congestive heart failure and a history of lung cancer was diagnosed with AML, with IDH2 and DNMT3A mutations detected by NGS. Since she had initially undergone low-intensity induction with Ven-Aza, her maintenance therapy included repeated cycles of Ven-Aza, with dose modifications post-remission. |
| The case series supports incorporating post-remission maintenance as part of SoC in AML. Further studies are needed to establish safe discontinuation of maintenance therapies and the routine use of high-sensitivity MRD assays in decision-making. |
Abbreviations: allo-HSCT, allogeneic hematopoietic stem cell transplantation; AML, acute myeloid leukemia; Aza, azacitidine; CR, complete remission; FLAG-Ida, fludarabine, idarubicin, cytarabine; ITD, internal tandem duplication; GO, gemtuzumab ozogamicin; MRD, measurable residual disease; NGS, next-generation sequencing; SoC, standard of care; Ven, venetoclax.
- Roboz GJ, Canaani J. How I use maintenance therapy in acute myeloid leukemia. Blood. 2024. Online ahead of print. DOI: 1182/blood.2024024009
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