iwAL 2025 | The value of maintenance therapy in AML and optimization strategies

Maintenance therapy in AML happens because we’re not sure about the patient staying in remission, right? So that’s fundamentally why maintenance is out there because we’re not sure. Did we get it all is really the question. And maintenance was a thing in acute promyelocytic leukemia until it wasn’t because we didn’t need it anymore when the therapy got better and the disease was eradicated. It is a thing still in ALL patients. It is still a thing in BCR-ABL positive patients. So I think it’s here to stay for a while in AML. And I think a lot of patients should be considered for maintenance because there are better-tolerated agents and plenty of subgroups where we are quite worried that the period of time of relapse is going to be within the first couple of years. So I do think that things like hypomethylating agents and some of the targeted therapies for maintenance are becoming both feasible and they make sense. We will optimize it by having trials that are of fixed duration. So when we did the QUAZAR trial of oral azacitidine, it was on indefinitely, which is a problem because patients who are now doing well, we’re not exactly sure whether it’s okay to stop the drug, and typically we don’t. So I think time-limited therapy for maintenance trials is going to be important. And obviously, all of the subgroups of AML which are going to benefit from having a reliable MRD marker, well, those patients are going to be in a better category. But I would conclude by saying that one of the ways currently, as of today, that we can optimize maintenance is to actually use it. And I am still surprised that there are plenty of patients who would fall within the indicated use cases for maintenance treatment who aren’t getting it. And I’m never exactly sure why that is.

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