Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Semin Hematol. 2019 Apr;56(2):102-109. doi: 10.1053/j.seminhematol.2018.08.006. Epub 2018 Aug 28.
Relapse remains the primary obstacle to long-term survival in patients with acute myeloid leukemia (AML) who achieve a remission following standard induction and consolidation therapy. Although allogeneic hematopoietic stem cell transplantation decreases the risk of relapse for many patients, relapse is common even among these patients. A number of approaches to maintenance therapy for AML have been studied with the goal of finding an agent with a tolerable side effect profile that may be given to patients in remission, typically for a prolonged period of time, in order to decrease the risk of relapse. Numerous trials that evaluated cytotoxic agents as maintenance therapy did not find any improvement in survival, but more recent studies of alternative approaches to maintenance including immunomodulation, epigenetic reprogramming, and targeted agents have been much more promising. In this article, we review the current evidence for various maintenance strategies for AML including immunotherapy, hypomethylating agents, and targeted therapies, particularly FLT3 inhibitors. We also discuss promising emerging approaches to maintenance for AML, including the incorporation of measurable residual disease assessment.
对于接受标准诱导和巩固治疗后缓解的急性髓系白血病 (AML) 患者，复发仍然是长期生存的主要障碍。尽管异基因造血干细胞移植降低了许多患者的复发风险，但即使在这些患者中，复发也很常见。已经研究了许多 AML 的维持治疗方法，目的是找到一种具有可耐受的副作用谱的药物，可用于缓解期的患者，通常需要延长一段时间，以降低复发风险。许多评估细胞毒性药物作为维持治疗的试验并未发现生存有任何改善，但最近对替代维持方法的研究，包括免疫调节、表观遗传重编程和靶向药物，更有希望。在本文中，我们回顾了 AML 各种维持策略的现有证据，包括免疫疗法、低甲基化剂和靶向治疗，特别是 FLT3 抑制剂。我们还讨论了 AML 维持治疗中很有前途的新兴方法，包括纳入可测量残留疾病评估。
