Life after transplant: are we becoming high maintenance in AML?
Allogeneic hematopoietic cell transplantation (allo-HCT) for patients with AML is increasingly able to impact the historically poor outcomes in this disease. Nonetheless, even with transplant, the rates of post-HCT relapse are unacceptably high, and remain a great challenge in the treatment of patients with AML. Maintenance therapies after allo-HCT, given to patients at high risk of relapse or with evidence of minimal residual disease (MRD), may provide a way to reduce relapse rates and improve survival. New therapies may offer acceptable toxicity profiles in the post-HCT setting, and investigations are ongoing using hypomethylating agents, histone deacetylase inhibitors, immunomodulatory drugs, targeted tyrosine kinase inhibitors, drug-antibody conjugates and cellular therapies. Future directions in the field of post-HCT therapies may include better risk stratification with MRD, as well as the exploitation of novel mechanisms such as immune checkpoint inhibition and modified chimeric antigen receptor (CAR) T cells. In this mini review, we discuss the current landscape of clinical research in post-HCT maintenance therapies, as well as future therapeutic strategies of interest. Although there is great potential for post-HCT agents to improve AML outcomes, these will need to be evaluated prospectively through well-designed randomized clinical trials.
Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA.
A M
AM
Brunner
Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA.
A T
AT
Fathi
Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA.
Y B
YB
Chen
D000970:Antineoplastic Agents / Q000627:therapeutic use; D005544:Forecasting; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D018365:Neoplasm, Residual / Q000188:drug therapy; D012008:Recurrence
D000970:Antineoplastic Agents