Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Hematology and Stem Cell Transplantation and Cellular Therapies Unit (CTMO), Reggio Calabria, Italy.
Stem Cell Transplant Program CIC587, Reggio Calabria, Italy.
Expert Rev Hematol. 2024 Aug;17(8):515-525. doi: 10.1080/17474086.2024.2382300. Epub 2024 Jul 21.
Despite the prognosis of patients affected by acute myeloid leukemia (AML) improved in the last decade, most patients relapse. Maintenance therapy after a chemotherapy approach with or without allogeneic stem cell transplantation could be a way to control the undetectable residual burden of leukemic cells. Several studies are being carried out as maintenance therapy in AML. Some critical points need to be defined, how the physician can choose among the various drugs available.
This review discusses the advances and controversies surrounding maintenance therapy for AML patients.
Patients withFLT3-positive AML should receive midostaurin or quizartinib in the first-linesetting. For a patient initially receiving midostaurin, consider switching to sorafenib in the post-transplant setting. Because of the improved safety profile and potency, many experts will lean toward using a second-generation FLT3 inhibitor such as quizartinib or gilteritinib. Finally, no data indicate whether maintenance therapy should be prolonged until progression or for a defined period.
尽管过去十年间急性髓系白血病（AML）患者的预后有所改善，但大多数患者仍会复发。在化疗方法（伴或不伴同种异体干细胞移植）后进行维持治疗可能是控制白血病细胞无法检测到的残留负担的一种方法。目前正在进行多项作为 AML 维持治疗的研究。需要确定一些关键点，例如医生如何在可用的各种药物中进行选择。
本篇综述讨论了 AML 患者维持治疗的进展和争议。
FLT3 阳性 AML 患者应在一线治疗中接受米哚妥林或quizartinib。对于最初接受米哚妥林的患者，可考虑在移植后使用索拉非尼。由于安全性和疗效更好，许多专家将倾向于使用第二代 FLT3 抑制剂，如 quizartinib 或 gilteritinib。最后，没有数据表明维持治疗应该延长到进展或规定的时间。
