Survival benefit of maintenance therapy in AML: a retrospective study in Iran

Abstract Purpose Acute myeloid leukemia (AML) is associated with high relapse rates even in patients who achieve complete remission. The lack of availability of oral azacitidine in some countries has limited its use. This study aimed to compare the outcomes of AML patients with and without maintenance therapy using available drugs. Methods This retrospective cohort study reviewed the charts of AML patients treated in oncology centers in northeast Iran from February 2015 to February 2021. The study included patients who experienced complete remission following induction and consolidation chemotherapy and did not undergo Allogeneic Hematopoietic Stem Cell Transplantation. Patients were categorized based on whether they received maintenance therapy after first-line treatment or were only followed up. Overall survival (OS) and disease-free survival (DFS) were compared between these groups. Results A total of 100 patients (1:1 ratio) met the inclusion criteria. There were no significant differences between the two groups. 39 individuals (78%) in the follow-up group and 26 individuals (54.2%) in the maintenance group died between complete remission and February 2021 (p = 0.01). The Median (95% CI) DFS in the follow-up and maintenance groups were 11 (8.6–13.3) and 18 (7.3–28.6) months, respectively (P = 0.03). The median OS (95% CI) was 16 (10.8–21.1) months in the follow-up group and 23 (10.8–35) months in the maintenance group (P = 0.04). Further comparisons between patients who received subcutaneous cytarabine and oral thioguanine revealed no significant differences in DFS or OS. Conclusion The study results suggest that maintenance therapy with subcutaneous cytarabine or oral thioguanine after complete remission in patients with AML is associated with improved DFS and OS.