Maintenance Therapy in Acute Myeloid Leukemia: Current Perspectives and Future Directions

Area of Science:

• Hematology
• Oncology
• Clinical Trials

Background:

• Acute myeloid leukemia (AML) management faces challenges with high relapse rates.
• Relapse prevention is a critical unmet need, especially for patients not eligible for or at high risk after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Purpose of the Study:

• To review current evidence on maintenance strategies for AML post-remission therapy.
• To emphasize measurable residual disease (MRD)-guided approaches and targeted therapies for relapse prevention.

Main Methods:

• Review of randomized and phase II/III trials.
• Evaluation of hypomethylating agents, FLT3 inhibitors, IDH inhibitors, and immunotherapies.
• Focus on post-remission settings and allo-HSCT.

Main Results:

• Oral azacitidine (CC-486) improved overall survival in older, transplant-ineligible patients in first complete remission.
• Post-transplant maintenance with FLT3 inhibitors (sorafenib, gilteritinib) reduced relapse risk in FLT3-mutated AML.
• MRD is emerging as a biomarker for targeted therapy benefit.

Conclusions:

• Maintenance strategies are evolving towards precision-based relapse prevention.
• Oral azacitidine is a new standard of care for specific older AML patients.
• Ongoing trials will refine optimal use of targeted agents and immunotherapies in AML post-remission management.