Current Treatment Options in Oncology

, Volume 8, Issue 4, pp 296–304

Maintenance for Acute Myeloid Leukemia Revisited

  • Thomas Büchner
  • Utz Krug
  • Wolfgang E. Berdel
  • Achim Heinecke
  • Maria Cristina Sauerland
  • Bernhard Wörmann
  • Wolfgang Hiddemann
Acute Leukemia

DOI: 10.1007/s11864-007-0041-1

Cite this article as:
Büchner, T., Krug, U., Berdel, W.E. et al. Curr. Treat. Options in Oncol. (2007) 8: 296. doi:10.1007/s11864-007-0041-1

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.

Copyright information

© Current Science Inc. 2007

Authors and Affiliations

  • Thomas Büchner
    • 1
  • Utz Krug
    • 1
  • Wolfgang E. Berdel
    • 1
  • Achim Heinecke
    • 2
  • Maria Cristina Sauerland
    • 2
  • Bernhard Wörmann
    • 3
  • Wolfgang Hiddemann
    • 4
  1. 1.Department of Medicine, Hematology and OncologyUniversity of MünsterMunsterGermany
  2. 2.Department of Medical Informatics and BiomathematicsUniversity of MünsterMunsterGermany
  3. 3.Department of Hematology and OncologyMunicipal Medical CenterBraunschweigGermany
  4. 4.Department of Internal Medicine IIIUniversity of MunichMunichGermany