Current Treatment Options in Oncology

, Volume 8, Issue 4, pp 296–304

Maintenance for Acute Myeloid Leukemia Revisited

Authors

    • Department of Medicine, Hematology and OncologyUniversity of Münster
  • Utz Krug
    • Department of Medicine, Hematology and OncologyUniversity of Münster
  • Wolfgang E. Berdel
    • Department of Medicine, Hematology and OncologyUniversity of Münster
  • Achim Heinecke
    • Department of Medical Informatics and BiomathematicsUniversity of Münster
  • Maria Cristina Sauerland
    • Department of Medical Informatics and BiomathematicsUniversity of Münster
  • Bernhard Wörmann
    • Department of Hematology and OncologyMunicipal Medical Center
  • Wolfgang Hiddemann
    • Department of Internal Medicine IIIUniversity of Munich
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
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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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© Current Science Inc. 2007