Post-HCT maintenance therapy for AML: who, when, why, how long?

Patients with acute myeloid leukemia (AML) often undergo allogeneic hematopoietic cell transplantation (HCT) as it represents a highly effective treatment to prevent relapse of their disease. While HCT is an important part of curative therapy for many AML patients, post-HCT relapse still occurs, and so post-HCT maintenance therapy is offered to some patients-often without any reliable evidence supporting its use. More and more molecularly targeted drugs are emerging in the field, and while there is randomized data supporting the use of FLT3 inhibitors in this setting, no other drug class has been convincingly shown to benefit these patients (yet). In acknowledgment of the fact that clinicians will continue to offer post-HCT maintenance in the hope of improving outcomes, this review focuses on the data (or lack thereof) directly supporting this practice, as well as some of the pitfalls that can be encountered with these drugs when used as maintenance.