Is it time to change conventional consolidation chemotherapy for acute myeloid leukemia in CR1?

Ofir Wolach, Richard M. Stone*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

PURPOSE OF REVIEW: Choosing the most appropriate postremission therapy (PRT) for a patient with acute myeloid leukemia (AML) in first complete remission remains a challenging task. Factors such as risk for disease relapse, nonrelapse mortality associated with different PRT approaches, donor availability, prospects for salvage should disease relapse, and patient preference all affect PRT choice. RECENT FINDINGS: New genetic markers refine AML risk stratification and identify patients within the 'classical' risk groups who may benefit from transplant-based or chemotherapy-based PRT. The use of minimal residual disease in first remission to guide PRT choice and the application of novel, targeted therapies have the potential to alter PRT approaches across AML risk groups. The advent of alternative donor sources, use of reduced intensity regimens, and improved supportive care all affect the availability and safety of transplant-based PRT and challenge the relevance of the older legacy 'donor/no-donor' genetically randomized trials. SUMMARY: Genetic risk assessment, monitoring of minimal residual disease in first remission, use of targeted agents, and the newer transplant strategies all have the potential to 'personalize' PRT choice in the AML patient. The clinical value of these novel interventions awaits validation in prospective, risk-adapted clinical trials.

Original languageEnglish
Pages (from-to)123-131
Number of pages9
JournalCurrent Opinion in Hematology
Volume22
Issue number2
DOIs
StatePublished - 13 Mar 2015
Externally publishedYes

Keywords

  • acute myeloid leukemia
  • allogeneic stem cell transplant
  • first remission
  • postremission therapy

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