Lower intensity regimens for acute myeloid leukemia: opportunities and challenges

Acute myeloid leukemia (AML) is an aggressive hematological malignancy for whom most patients a hematopoietic stem cell transplant (HSCT) is the only curative treatment modality. Intensive chemotherapy has been the first-line treatment for AML for many years but has significant morbidity and mortality in elderly patients and those with comorbidities, who constitute the majority of patients with this disease. Since 2017, multiple new lower intensity therapies have been approved for the treatment of AML. Their advantages include decreased hematological and non-hematological side effects, lower rates of infections and the ability to be given in an outpatient setting. For HSCT, reduced intensity conditioning (RIC) regimens have improved for older and comorbid patients, allowing potent graft vs. tumor effects with lower toxicity profiles, resulting in the expansion of this therapy to more patients. More studies are required to improve and refine lower intensity regimens as well as RIC, as they are increasingly utilized in AML treatment.