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Peer-reviewedCC BY 4.0Cancers

Maintenance Therapy After Allogeneic Stem Cell Transplantation in Acute Myeloid Leukemia: Still an Open Question?

  • Alessandra Sperotto1,2
  • Federico De Marchi1
  • Marco Basso3
  • Giulia Ciotti1
  • Alessandro Atanasio1
  • Roberta De Marchi1,2
  • Michele Gottardi1
  1. 1UOSD Terapie Cellulari, Dipartimento di Oncologia, Istituto Oncologico Veneto (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 35128 Padua, Italy
  2. 2UOC Oncoematolgia, Dipartimento di Oncologia, Istituto Oncologico Veneto (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 35128 Padua, Italy
  3. 3UOC Farmacia, Dipartimento di Oncologia Traslazionale e dei Servizi Trasversali, Istituto Oncologico Veneto (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 35128 Padua, Italy
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Abstract

Disease relapse remains the leading cause of treatment failure in patients with acute myeloid leukemia (AML) undergoing allogeneic hematopoietic cell transplantation (allo-HCT). This narrative review, searched from Pubmed, from 2015 to 2026, critically synthesizes the available evidence on post-transplant maintenance strategies, which have evolved over the past three decades from conventional chemotherapy to molecularly targeted agents and interventions aimed at modulating antileukemic immunity. Particular attention is given to the biological rationale, efficacy, safety, and clinical applicability of these approaches, as well as to the substantial heterogeneity in study design, patient selection, and treatment initiation and duration. The available evidence indicates that the potential benefit of maintenance is unlikely to be uniform across all recipients and should be interpreted in relation to AML molecular features, baseline relapse risk, prior treatment exposure, measurable residual disease status, expected toxicity, and the patient’s overall clinical condition. Although selected strategies may prolong remission and improve survival, the optimal agent, timing, duration, and target population remain incompletely defined. Current evidence therefore supports a risk-adapted and molecularly informed approach, while underscoring the need for adequately powered prospective studies using standardized endpoints and incorporating quality-of-life outcomes.

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Cite

BibTeXRIS
BibTeX
@article{sperotto2026maintenance,
  title = {{Maintenance Therapy After Allogeneic Stem Cell Transplantation in Acute Myeloid Leukemia: Still an Open Question?}},
  author = {Alessandra Sperotto and Federico De Marchi and Marco Basso and Giulia Ciotti and Alessandro Atanasio and Roberta De Marchi and Michele Gottardi},
  journal = {Cancers},
  year = {2026},
  month = oct,
  doi = {10.3390/cancers18213487},
  url = {https://www.mdpi.com/2072-6694/18/21/3487},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Maintenance Therapy After Allogeneic Stem Cell Transplantation in Acute Myeloid Leukemia: Still an Open Question?
AU  - Alessandra Sperotto
AU  - Federico De Marchi
AU  - Marco Basso
AU  - Giulia Ciotti
AU  - Alessandro Atanasio
AU  - Roberta De Marchi
AU  - Michele Gottardi
PY  - 2026
DA  - 2026/10/29
JO  - Cancers
DO  - 10.3390/cancers18213487
UR  - https://www.mdpi.com/2072-6694/18/21/3487
AB  - Disease relapse remains the leading cause of treatment failure in patients with acute myeloid leukemia (AML) undergoing allogeneic hematopoietic cell transplantation (allo-HCT). This narrative review, searched from Pubmed, from 2015 to 2026, critically synthesizes the available evidence on post-transplant maintenance strategies, which have evolved over the past three decades from conventional chemotherapy to molecularly targeted agents and interventions aimed at modulating antileukemic immunity. Particular attention is given to the biological rationale, efficacy, safety, and clinical applicability of these approaches, as well as to the substantial heterogeneity in study design, patient selection, and treatment initiation and duration. The available evidence indicates that the potential benefit of maintenance is unlikely to be uniform across all recipients and should be interpreted in relation to AML molecular features, baseline relapse risk, prior treatment exposure, measurable residual disease status, expected toxicity, and the patient’s overall clinical condition. Although selected strategies may prolong remission and improve survival, the optimal agent, timing, duration, and target population remain incompletely defined. Current evidence therefore supports a risk-adapted and molecularly informed approach, while underscoring the need for adequately powered prospective studies using standardized endpoints and incorporating quality-of-life outcomes.
SN  - 2072-6694
ER  -