Understanding Maintenance Therapy for Acute Myeloid Leukemia

Maintenance therapy is treatment given after the first treatments have worked well. The goal of maintenance therapy is to prevent cancer from coming back. 

Some examples of maintenance therapy include: 

• Oral medication
• Lower doses of chemotherapy
• Injections or infusions

When is maintenance therapy given for acute myeloid leukemia (AML)?

There are several different therapies used to treat AML. You may receive chemotherapy, targeted therapy, radiation therapy, and/or a stem cell transplant. 

The first treatment is called induction therapy. This is a high-intensity treatment that destroys as many leukemia cells as possible. That is followed by consolidation therapy, which is another round of intensive treatment to get rid of any remaining cancer cells. Maintenance therapy is given after these treatments have worked well to control the cancer.  

In AML, MRD negativity is when  very sensitive tests cannot find any remaining leukemia cells after treatment. MRD negativity is associated with lower risk of relapse and better long-term outcomes. Once MRD negativity is reached, your healthcare team may recommend maintenance therapy. 

What are the maintenance therapy treatment options for AML?

For people with acute myeloid leukemia (AML) , maintenance therapy is usually less intense than the initial treatment. One common treatment is a lower dose of oral azacitidine. Azacitidine is a type of chemotherapy known as a nucleoside metabolic inhibitor. It helps reduce the number of abnormal cells in the blood. 

Another commonly used maintenance therapy for AML is an FLT3 inhibitor. Some people with AML have a mutation of the FLT3 gene. This gene is responsible for the normal development of bone marrow stem cells. FLT3 inhibitors target the mutated FLT3 gene and help reduce the growth of AML cells. 

Maintenance therapy is a very individualized part of your care. Not everyone will be put on a maintenance plan. Your care team will consider factors like your age, overall health, and prior treatment before deciding if maintenance therapy is right for you.  

What to expect during maintenance therapy for AML 

Regular monitoring

Regular monitoring is a key part of maintenance therapy. Treatment can be long term, so it is important to understand the impact that treatment can have over time. Regular monitoring may include blood tests and bone marrow tests during follow-up appointments. All of this can help your care team better understand if the maintenance therapy is working to prevent relapse.   

Side effects

The side effects that you experience with maintenance therapy can vary depending on the type of treatment. Your care team may make changes to your dose to help resolve symptoms. In some cases, your doctor may prescribe medications to help ease symptoms.  Keeping track of your symptoms over time will help doctors make changes that make treatment more manageable for you. 

Questions to ask your doctor about maintenance therapy 

• What specific maintenance therapy do you recommend for me?
• How long will I be on the maintenance therapy 
• What are the risks of this treatment 
• How will this therapy affect my day-to-day life
• What signs and symptoms should I look out for?

When you securely connect your records to HealthTree, all of your health information is in one place. You can monitor your labs, see out of range values, and also learn about what has worked for others with AML. Additionally, researchers can use the anonymized data in the portal to make important scientific discoveries that can help improve treatment and ultimately lead to cures. Follow the link below to connect your records.

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Sources:

• NIH-Maintenance Therapy 
• How I use maintenance therapy in acute myeloid leukemia