Post-transplant maintenance therapy in acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation harmonizing multiple therapeutic modalities including targeted therapy, immunotherapy and cellular therapy

Post-Transplant Maintenance Therapy in Acute Myeloid Leukemia

“…Acute myeloid leukemia (AML) is a heterogeneous group of blood cell cancers that arise from the clonal expansion of malignant hematopoietic precursor cells in the bone marrow, which contributes to the aggressive nature of this cancer [ 1 ]. The prognosis varies based on age, comorbidities, and cytogenic and mutation status [ 1 , 2 , 3 ].…”

“…Acute myeloid leukemia (AML) is a heterogeneous group of blood cell cancers that arise from the clonal expansion of malignant hematopoietic precursor cells in the bone marrow, which contributes to the aggressive nature of this cancer [ 1 ]. The prognosis varies based on age, comorbidities, and cytogenic and mutation status [ 1 , 2 , 3 ]. Treatment is initiated with standard induction chemotherapy to induce a complete remission (CR) which will be followed by consolidation chemotherapy or allogeneic hematopoietic stem cell transplantation (allo-HCT) depending on disease risk based on cytogenetic and molecular aberrations at presentation and response to therapy assessed by measurable residual disease (MRD) at the time of transplant, donor availability, comorbidities, age, and performance status [ 1 , 2 , 3 ].…”

“…The prognosis varies based on age, comorbidities, and cytogenic and mutation status [ 1 , 2 , 3 ]. Treatment is initiated with standard induction chemotherapy to induce a complete remission (CR) which will be followed by consolidation chemotherapy or allogeneic hematopoietic stem cell transplantation (allo-HCT) depending on disease risk based on cytogenetic and molecular aberrations at presentation and response to therapy assessed by measurable residual disease (MRD) at the time of transplant, donor availability, comorbidities, age, and performance status [ 1 , 2 , 3 ]. If the patient is determined to have intermediate- or adverse-risk AML, allo-HCT is strongly recommended.…”

“…Unfortunately, the risk of relapse has not seen the same degree of reduction over the past several years. Now, the focus of recent research has shifted to investigating different approaches to prevent relapse after allo-HCT since around 20–30% of patients with AML will relapse in the first 1–2 years following allo-HCT and a shorter time to relapse is correlated with worse outcomes [ 1 , 2 , 3 , 6 ]. After relapse, the prognosis is poor, and the median survival is only 4–6 months, with a 1-year survival rate of less than 20% [ 1 , 2 , 3 , 6 ].…”

“…Now, the focus of recent research has shifted to investigating different approaches to prevent relapse after allo-HCT since around 20–30% of patients with AML will relapse in the first 1–2 years following allo-HCT and a shorter time to relapse is correlated with worse outcomes [ 1 , 2 , 3 , 6 ]. After relapse, the prognosis is poor, and the median survival is only 4–6 months, with a 1-year survival rate of less than 20% [ 1 , 2 , 3 , 6 ]. These figures represent the importance of identifying strategies to decrease rates of relapse and improve post-transplant survival.…”