Deparment of Medicine, Division of Hematology/Oncology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA.
Division of Hematology and Transplant Center, Mayo Clinic, Rochester, MN, USA.
Blood Rev. 2021 Nov;50:100863. doi: 10.1016/j.blre.2021.100863. Epub 2021 Jun 21.
In the recent years, there have been multiple approvals by the Food and Drug Administration (FDA) for therapeutics for acute myeloid leukemia (AML). The role of maintenance therapy in AML has been rather unrealized mostly due to lack of efficacy and increased toxicity of classical chemotherapy agents. Many clinical trials have demonstrated a disease-free survival benefit for various therapeutics in the maintenance setting for patients with AML who are ineligible for stem cell transplant. Notably, oral hypomethylating agent therapy has recently shown an overall survival and disease-free survival benefit in the maintenance setting for AML. In this review, we summarize the relevant data on maintenance therapy with a specific focus on cytotoxic antimetabolite chemotherapeutics, hypomethylating agents, targeted agents, and immunotherapeutics. We discuss our approach to maintenance therapy in AML in 2021 and propose a measurable residual disease (MRD)-adapted, personalized approach based on the best available evidence.
近年来，美国食品和药物管理局 (FDA) 已批准多种治疗急性髓系白血病 (AML) 的药物。由于经典化疗药物的疗效和毒性增加，维持治疗在 AML 中的作用尚未得到充分认识。许多临床试验表明，对于不适合干细胞移植的 AML 患者，各种治疗药物在维持治疗中的无病生存期均有获益。值得注意的是，最近在 AML 的维持治疗中，口服低甲基化剂治疗显示出总生存期和无病生存期的获益。在这篇综述中，我们总结了维持治疗的相关数据，重点介绍细胞毒性抗代谢化疗药物、低甲基化剂、靶向药物和免疫治疗药物。我们讨论了我们在 2021 年对 AML 维持治疗的方法，并根据现有最佳证据提出了一种基于可测量残留疾病 (MRD) 的个体化方法。
