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Maintenance for Acute Myeloid Leukemia Revisited

  • Acute Leukemia
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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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Acknowledgments

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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Authors and Affiliations

  1. Department of Medicine, Hematology and Oncology, University of Münster, Albert-Schweitzer-Str. 33, Munster, 48129, Germany

    Thomas Büchner, Utz Krug & Wolfgang E. Berdel

  2. Department of Medical Informatics and Biomathematics, University of Münster, Munster, Germany

    Achim Heinecke & Maria Cristina Sauerland

  3. Department of Hematology and Oncology, Municipal Medical Center, Braunschweig, Germany

    Bernhard Wörmann

  4. Department of Internal Medicine III, University of Munich, Munich, Germany

    Wolfgang Hiddemann

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  1. Thomas Büchner
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  2. Utz Krug
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  3. Wolfgang E. Berdel
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  4. Achim Heinecke
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  5. Maria Cristina Sauerland
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  6. Bernhard Wörmann
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  7. Wolfgang Hiddemann
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Correspondence to Thomas Büchner.

Additional information

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

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