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General Updates | Post-remission therapy in older adults with newly diagnosed AML and when to consider transplant
Jeffrey Lancet, MD, Moffitt Cancer Center, Tampa, FL, discusses the approach to post-remission therapy for older patients with newly diagnosed acute myeloid leukemia (AML) who have achieved remission, highlighting the importance of capitalizing on this period to improve long-term outcomes. Dr Lancet notes that the recently published American Society of Hematology (ASH) 2025 guidelines recommend post-remission therapy for all patients who achieve remission and are fit enough to receive it, regardless of whether the remission was achieved with intensive or lower-intensity treatment. In those patients who are considered fit and have non-favorable disease biology, stem cell transplantation should be considered at first remission. This interview took place virtually.
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Transcript
So this is an important question because once you achieve a remission, you want to capitalize on that remission state and help patients live as long and as well as possible. In general, the guidelines recommend post-remission therapy for all patients that achieve remission if they are well enough to receive it. And it doesn’t matter whether it’s a patient that’s received more intensive therapy or a lower intensity therapy to achieve the remission...
So this is an important question because once you achieve a remission, you want to capitalize on that remission state and help patients live as long and as well as possible. In general, the guidelines recommend post-remission therapy for all patients that achieve remission if they are well enough to receive it. And it doesn’t matter whether it’s a patient that’s received more intensive therapy or a lower intensity therapy to achieve the remission. For a patient who achieves remission with a more intensive-based approach, post-remission therapy in the form of some number of consolidation therapy cycles and possibly maintenance therapy should strongly be considered. For patients who achieve a remission with lower-intensity therapy, such as HMA plus venetoclax, those patients should continue on with that level of therapy, typically continuation of HMA plus venetoclax on an indefinite basis until the patient decides they don’t want it anymore or they’re not tolerating it anymore. But that therapy should not be abruptly discontinued for other reasons.
For transplant, it’s a bit of a trickier issue. Certainly transplant is still potentially curative in older patients. It’s unfortunately not an option in as many older patients because of comorbidities and risk of transplant-related morbidity and mortality. But in general, in a suitably healthy patient who’s older and is in first remission, a transplant should strongly be considered for those patients who have non-favorable disease biology. So for example, patients that have an NPM1 mutation or patients that have a core binding factor leukemia probably are not the ones that should be transplanted in first remission, similar to the approach we take with younger patients. But if patients have a non-favorable disease biology, intermediate risk or adverse risk and are fit should be strongly considered for transplant in first remission because outcomes do seem to favor transplanted versus non-transplanted patients in this setting.
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