Während das „7+3“-Regime bestehend aus Cytarabin und Anthracyclin lange Zeit das Rückgrat
der Behandlung der Akuten Myeloischen Leukämie (AML) war, wurden in den letzten 5 Jahren mehrere
neuartige Medikamente zugelassen. Trotz dieser vielversprechenden neuartigen Therapieoptionen
bleibt die Behandlung der AML angesichts des biologisch heterogenen Charakters der Erkrankung
eine Herausforderung. Diese Übersicht bietet ein Update zu neuen Behandlungsstrategien der
AML.
Abstract
Background While the “7+3” regimen of cytarabine + anthracycline
has been the backbone of acute myeloid leukemia (AML) treatment for four decades, several
novel drugs have been approved in the past five years. Despite these promising novel
therapeutic options, treatment of AML remains challenging, given the biologically heterogenous
character of the disease.
Aim This review provides an update on novel treatment strategies
for AML.
Material and Methods This article is based on the current
European LeukemiaNet (ELN) recommendations and the DGHO «Onkopedia» guideline on AML
treatment.
Results and Conclusion The treatment algorithm is based on
patient-related and disease-specific factors, such as patient age and fitness as well as AML
molecular profile. Younger patients considered fit for intensive chemotherapy receive 1–2
courses of induction therapy (“7+3” regimen, eg. cytarabine/daunorubicin, or CPX-351 for
patients with myelodysplasia-related AML or therapy-related AML). For CD33+ patients or those
with evidence of an FLT3 mutation “7+3” in combination with
Gemtuzumab-Ozogamicin (GO) or Midostaurin is recommended, respectively. For consolidation,
patients receive either high-dose chemotherapy (± GO/± Midostaurin) or undergo allogeneic
hematopoietic cell transplantation (HCT), based on ELN risk stratification. In some cases,
maintenance therapy with oral azacytidine or FLT3 inhibitor is
indicated. Patients experiencing relapse should receive chemotherapy-based re-induction
therapy or, in case of an FLT3 mutation, Gilteritinib and
subsequently undergo allogeneic HCT. For older patients or those considered unfit for
intensive therapy, azacytidine in combination with Venetoclax is a promising novel treatment
strategy. Although not yet approved by the European Medical Agency (EMA), for patients with
IDH1IDH1 or IDH2 mutations treatment
with the IDH1 and IDH2 inhibitors Ivosidenib and Enasidenib should be considered.
Schlüsselwörter
myeloische Neoplasien - akute myeloische Leukämie - Risikostratifizierung - molekularzielgerichtete Therapie
Keywords
myeloid neoplasms - acute myeloid leukemia - risk stratification - molecular-guided treatment
