Maintenance Therapy in Acute Myeloid Leukemia:  A New Standard of Care

Andre Schuh

Authors

Andre Schuh, MD Princess Margaret Cancer Centre, Toronto, ON, University of Toronto, Toronto, ON

Abstract

Initial adult acute myeloid leukemia (AML) treatment is generally divided into two intensity-based approaches based on patient (age, comorbidities, patient preference, among others) and disease (genetic risk, natural history [de novo vs. secondary AML (sAML) vs. therapy-related AML (tAML)], among others) factors. For those patients deemed appropriate for intensive treatment, current approaches result in the achievement of a complete remission (CR) in a majority of cases. In such patients, remissions are generally consolidated by further cycles of chemotherapy, or by additional chemotherapy followed by an allogenic hematopoietic stem cell transplant (alloHSCT), as appropriate, depending on patient and disease factors as above.

Author Biography

Andre Schuh, MD, Princess Margaret Cancer Centre, Toronto, ON, University of Toronto, Toronto, ON

Dr. Andre Schuh is a staff hematologist at the Princess Margaret Cancer Centre, and a Professor of Medicine at the University of Toronto, Toronto, Ontario, Canada. He has been at Princess Margaret since 1992, where he has focused on acute leukemia and MDS, and has managed an extensive clinical trial portfolio. In addition to a variety of other administrative roles, he was the head of the leukemia program at Princess Margaret from 2010–2014, and from 2012–2018, was Medical Director, Malignant Hematology. His current interests include acute leukemia management and clinical trials (especially in the older patient), and the development of Canadian province- and country-wide leukemia management strategies. He is the founding Chair of the Canadian Leukemia Study Group (CLSG)/Groupe Canadien d’Étude Sur La Leucémie (GCEL), a country-wide cooperative of leukemia-treaters who share the goal of improving acute leukemia diagnosis and management across Canada, by identifying and defining diagnostic and management best practices, promoting Canada-wide standards-of-care, fostering clinical and basic leukemia research, and improving new drug access.

References

Döhner H, Wei AH, Appelbaum FR, Craddock C, DiNardo CD, Dombret H, et al. Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN. Blood. 2022;140(12):1345-1377. doi:10.1182/blood.2022016867

Yanada M, Garcia-Manero G, Borthakur G, Ravandi F, Kantarjian H, Estey E. Potential cure of acute myeloid leukemia : analysis of 1069 consecutive patients in first complete remission. Cancer. 2007;110(12):2756-2760. doi:10.1002/cncr.23112

Röllig C, Bornhäuser M, Thiede C, Taube F, Kramer M, Mohr B, et al. Long-term prognosis of acute myeloid leukemia according to the new genetic risk classification of the European LeukemiaNet recommendations: evaluation of the proposed reporting system. J Clin Oncol. 2011;29(20):2758-2765. doi:10.1200/jco.2010.32.8500

DeWolf S, Tallman MS. How I treat relapsed or refractory AML. Blood. 2020;136(9):1023-1032. doi:10.1182/blood.2019001982

Toksvang LN, Lee SHR, Yang JJ, Schmiegelow K. Maintenance therapy for acute lymphoblastic leukemia: basic science and clinical translations. Leukemia. 2022;36(7):1749-1758. doi:10.1038/s41375-022-01591-4

Kilic Gunes E, Ozkurt ZN, Yildiz S, Ozet G, Ceran F, Albayrak M, et al. Comparison of maintenance regimens in acute promyelocytic leukemia patients. Leuk Res. 2023;128:107055. doi:10.1016/j.leukres.2023.107055

Storring JM, Minden MD, Kao S, Gupta V, Schuh AC, Schimmer AD, et al. Treatment of adults with BCR-ABL negative acute lymphoblastic leukaemia with a modified paediatric regimen. Br J Haematol. 2009;146(1):76-85. doi:10.1111/j.1365-2141.2009.07712.x

Sibai H, Chen R, Liu X, Falcone U, Schimmer A, Schuh A, et al. Anticoagulation prophylaxis reduces venous thromboembolism rate in adult acute lymphoblastic leukaemia treated with asparaginase-based therapy. Br J Haematol. 2020;191(5):748-754. doi:10.1111/bjh.16695

Rashidi A, Walter RB, Tallman MS, Appelbaum FR, DiPersio JF. Maintenance therapy in acute myeloid leukemia: an evidence-based review of randomized trials. Blood. 2016;128(6):763-773. doi:10.1182/blood-2016-03-674127

Reville PK, Kadia TM. Maintenance therapy in AML. Front Oncol. 2020;10:619085. doi:10.3389/fonc.2020.619085

Gagelmann N, Wolschke C, Klyuchnikov E, Christopeit M, Ayuk F, Kröger N. TKI maintenance after stem-cell transplantation for FLT3-ITD positive acute myeloid leukemia: a systematic review and meta-analysis. Front Immunol. 2021;12:630429. doi:10.3389/fimmu.2021.630429

Blackmon A, Aldoss I, Ball BJ. FLT3 Inhibitors as maintenance therapy after allogeneic stem-cell transplantation. Blood Lymphat Cancer. 2022;12:137-147. doi:10.2147/blctt.S281252

Perl AE, Larson RA, Podoltsev NA, Strickland S, Wang ES, Atallah E, et al. Outcomes in patients with FLT3-mutated relapsed/ refractory acute myelogenous leukemia who underwent transplantation in the phase 3 ADMIRAL trial of gilteritinib versus salvage chemotherapy. Transplant Cell Ther. 2023;29(4):265.e261-265.e210. doi:10.1016/j.jtct.2022.12.006

Huls G, Chitu DA, Havelange V, Jongen-Lavrencic M, van de Loosdrecht AA, Biemond BJ, et al. Azacitidine maintenance after intensive chemotherapy improves DFS in older AML patients. Blood. 2019;133(13):1457-1464. doi:10.1182/blood-2018-10-879866

Wei AH, Döhner H, Pocock C, Montesinos P, Afanasyev B, Dombret H, et al. Oral azacitidine maintenance therapy for acute myeloid leukemia in first remission. N Engl J Med. 2020;383(26):2526-2537. doi:10.1056/NEJMoa2004444

Wei AH, Döhner H, Sayar H, Ravandi F, Montesinos P, Dombret H, et al. Long-term survival with oral azacitidine for patients with acute myeloid leukemia in first remission after chemotherapy: Updated results from the randomized, placebo-controlled, phase 3 QUAZAR AML-001 trial. Am J Hematol. 2023;98(4):E84-e87. doi:10.1002/ajh.26847

Ravandi F, Roboz GJ, Wei AH, Döhner H, Pocock C, Selleslag D, et al. Management of adverse events in patients with acute myeloid leukemia in remission receiving oral azacitidine: experience from the phase 3 randomized QUAZAR AML-001 trial. J Hematol Oncol. 2021;14(1):133. doi:10.1186/s13045-021-01142-x

Roboz GJ, Döhner H, Pocock C, Dombret H, Ravandi F, Jang JH, et al. Oral azacitidine preserves favorable level of fatigue and health-related quality of life for patients with acute myeloid leukemia in remission: results from the phase 3, placebo-controlled QUAZAR AML-001 trial. Haematologica. 2021;106(12):3240-3244. doi:10.3324/haematol.2021.279174

Wei AH, Roboz GJ, Dombret H, Dohner H, Schuh AC, Montesinos P, et al. Survival outcomes with oral azacitidine maintenance in patients with acute myeloid leukemia in remission by receipt of initial chemotherapy: subgroup analyses from the phase III QUAZAR AML-001 trial. Haematologica. 2023;108(10):2820-2825. doi:10.3324/haematol.2022.282296

Döhner H, Estey E, Grimwade D, Amadori S, Appelbaum FR, Büchner T, et al. Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood. 2017;129(4):424-447. doi:10.1182/blood-2016-08-733196

Roboz GJ, Ravandi F, Wei AH, Dombret H, Thol F, Voso MT, et al. Oral azacitidine prolongs survival of patients with AML in remission independently of measurable residual disease status. Blood. 2022;139(14):2145-2155. doi:10.1182/blood.2021013404

Döhner H, Wei AH, Roboz GJ, Montesinos P, Thol FR, Ravandi F, et al. Prognostic impact of NPM1 and FLT3 mutations in patients with AML in first remission treated with oral azacitidine. Blood. 2022;140(15):1674-1685. doi:10.1182/blood.2022016293

O’Donnell MR, Abboud CN, Altman J, Appelbaum FR, Coutre SE, Damon LE, et al. Acute myeloid leukemia. J Natl Compr Canc Netw. 2011;9(3):280-317. doi:10.6004/jnccn.2011.0027

Ravandi F, Döhner H, Wei AH, Montesinos P, Pfeilstöcker M, Papayannidis C, et al. Survival outcomes in patients with acute myeloid leukaemia who received subsequent therapy for relapse in QUAZAR AML-001. Br J Haematol. 2023. doi:10.1111/bjh.19202

Maintenance Therapy in Acute Myeloid Leukemia: A New Standard of Care

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Author Biography

Andre Schuh, MD, Princess Margaret Cancer Centre, Toronto, ON, University of Toronto, Toronto, ON

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