Dr Lai on NCCN Guideline Updates in AML Maintenance Therapy

Catherine E. Lai, MD, MPH, associate professor, physician leader, the Leukemia Clinical Research Unit, University of Pennsylvania Perelman Center for Advanced Medicine, discusses recent updates to the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology for acute myeloid leukemia (AML) maintenance treatment, highlighting how these updates may influence treatment decisions for this population.

Lai begins by stating that the 2024 NCCN guidelines have expanded their recommendation for the use of oral azacitidine maintenance therapy. Previously, this treatment was primarily for patients with intermediate- or adverse-risk disease who had completed consolidation therapy and were not eligible for a transplant, she explains. However, the 2024 guidelines for azacitidine maintenance therapy now also include patients with favorable-risk profiles who do not exhibit core binding factors, Lai reports. This recommendation is based on data from a small subset of patients in the phase 3, double-blind, placebo-controlled QUAZAR AML-001 trial (NCT01757535), she states.

The decision to use oral azacitidine for maintenance therapy should be individualized and tailored to specific patients’ needs, Lai continues. Several factors must be considered, such as whether a patient is likely to benefit from this treatment, she notes. It’s essential to consider patients’ bothshort-term and long-term goals, as well as the number of cycles of consolidation therapy they have received, Lai emphasizes, adding that these factors can play a critical role in determining whether azacitidine maintenance therapy is appropriate.

Having oral azacitidine as an option in the maintenance setting is beneficial, especially when the use of this agent aligns with patients’ specific circumstances and treatment objectives, she continues. These expanded guidelines provide a valuable alternative for maintenance therapy, ensuring that each patient receives a treatment plan that is best suited to their individual health needs, Lai states. Therefore, careful assessment and personalized decision-making are crucial in determining the most suitable maintenance therapy for each patient, she concludes.