Neue Therapieoptionen bei der Akuten Myeloischen Leukämie

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

Publikationsverlauf

Artikel online veröffentlicht:
29. März 2023

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