Optimizing maintenance therapy in acute myeloid leukemia: where do we stand in the year 2024?

IF 2.3 4区医学 Q2 HEMATOLOGY Expert Review of Hematology Pub Date : 2024-08-01 Epub Date: 2024-07-21 DOI:10.1080/17474086.2024.2382300

Caterina Alati, Martina Pitea, Maria Caterina Mico, Violetta Marafioti, Bruna Greve, Giulia Pratico, Barbara Loteta, Francesca Cogliandro, Gaetana Porto, Giorgia Policastro, Giovanna Utano, Annalisa Sgarlata, Lucrezia Imbalzano, Ilaria Maria Delfino, Elisa Montechiarello, Jessyca Germano, Gianfranco Filippelli, Massimo Martino

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Abstract

Introduction: 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.

Areas covered: This review discusses the advances and controversies surrounding maintenance therapy for AML patients.

Expert opinion: 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.

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优化急性髓性白血病的维持治疗：2024 年我们将何去何从？

简介尽管急性髓性白血病（AML）患者的预后在过去十年中有所改善，但大多数患者仍会复发。无论是否进行异基因干细胞移植，化疗后的维持治疗都是控制无法检测到的白血病细胞残留的一种方法。目前正在就急性髓细胞白血病的维持疗法开展多项研究。需要明确一些关键点，以便医生如何在现有的各种药物中做出选择：本综述讨论了围绕急性髓细胞白血病患者维持治疗的进展和争议：FLT3阳性急性髓细胞性白血病患者在一线治疗中应接受米哚妥林或奎沙替尼治疗。对于最初接受米哚妥林治疗的患者，可考虑在移植后改用索拉非尼。由于安全性和有效性的提高，许多专家倾向于使用第二代FLT3 抑制剂，如喹沙替尼或吉特替尼。最后，没有数据表明维持治疗是否应延长至病情进展或确定的时间。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Hematology HEMATOLOGY-

CiteScore

4.70

自引率

3.60%

发文量

审稿时长

6-12 weeks

期刊介绍： Advanced molecular research techniques have transformed hematology in recent years. With improved understanding of hematologic diseases, we now have the opportunity to research and evaluate new biological therapies, new drugs and drug combinations, new treatment schedules and novel approaches including stem cell transplantation. We can also expect proteomics, molecular genetics and biomarker research to facilitate new diagnostic approaches and the identification of appropriate therapies. Further advances in our knowledge regarding the formation and function of blood cells and blood-forming tissues should ensue, and it will be a major challenge for hematologists to adopt these new paradigms and develop integrated strategies to define the best possible patient care. Expert Review of Hematology (1747-4086) puts these advances in context and explores how they will translate directly into clinical practice.