Opinion Statement
Maintenance treatment for AML is an approach to minimize residual disease, optimize quality of remission and prevent a leukemic regrowth over a longer period of time. This intention implies a certain antileukemic activity and myelotoxicity. Thus, a prolonged myelosuppressive maintenance is best exemplified by the optimized protocol of the CALGB published by Kanti R. Rai in 1981 (Blood 58:1203–1212, 1981) and derived by the AMLCG as a therapeutic standard. From our today’s knowledge about the impact of various strategies, a lack of postremission therapy is not compatible with durable remissions. Even after an induction-type consolidation, the classic CALGB-type maintenance, or a comparably intensive regimen improved the relapse-free survival over that from alternatives. Some studies which failed to show a benefit used maintenance at low-dosage or short duration. Data about maintenance delivery in patients reaching long-term remissions demonstrate feasibility and compliance, and a low maintenance-related death rate can compete with that from alternative options. Revisiting maintenance, however, requires a comparison with other strategies on the basis of intention-to-treat. Either single prospective trials or crosstrial networking by a common standard arm and general upfront randomization can further assess the relative value of maintenance for AML.
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Supported by grants No M17/92 Bü1 and 70-2839-Bü4 from Deutsche Krebshilfe, 01 G3 9976 from BMBF Competence Network Acute and Chronic Leukemias, LSH-2002-2.2.0-3 European LeukemiaNet from European Commission, and an unrestricted grant from AMGEN.
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TB and UK contributed equally and share first authorship of this report.
All the authors are belongs to AML Cooperative Group.
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Büchner, T., Krug, U., Berdel, W.E. et al. Maintenance for Acute Myeloid Leukemia Revisited. Curr. Treat. Options in Oncol. 8, 296–304 (2007). https://doi.org/10.1007/s11864-007-0041-1
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DOI: https://doi.org/10.1007/s11864-007-0041-1