Given the high rate of relapse, there is rationale and need for post remission maintenance therapy to mitigate this risk. However with the recent completion of the QUAZAR AML-001 clinical study and FDA approval of CC-486 (oral azacitidine) this paradigm maybe set to change ( 21). The current standard of care for most patients with AML achieving a CR with induction and consolidation is observation without maintenance therapy, with the exception of acute promyelocytic leukemia where maintenance arsenic trioxide and retinoic acid have shown clear benefit ( 19, 20). A major reason for the success of alloSCT in maintenance of remission and cure of AML is through the generation of allo-reactive T cells and graft versus leukemia (GVL) effect ( 16– 18). The most effective post remission therapy in AML continues to be alloSCT, but is not available to all patients with high-risk disease because high rates of complications limit broad applicability to patients with multiple comorbidities and some patients lack suitable donors ( 8, 13– 15). Patients with high risk AML that are ineligible for allogeneic hematopoietic stem cell transplantation (alloSCT) continue to have poor outcomes and low likelihood of cure ( 12). There is a critical need for therapeutic strategies that decrease this relapse risk and improve the survival of patients with AML. Despite these successes, relapse remains a major concern with relapse risk greater than 50% for all adults with high risk AML ( 9– 11). Consolidation therapy helps to eradicate residual leukemia and reduces the risk of disease relapse ( 2, 7, 8). For example, dose intensification and novel drug combinations during induction therapy have led to higher response rates and improved survival in patients with newly diagnosed AML ( 1– 6).
In this review we summarize prior and ongoing maintenance therapy approaches in AML and highlight some of the most promising strategies.Īdvances in therapeutics and supportive care for acute myeloid leukemia (AML) have led to steady improvements in the outcomes for patients with AML. Ongoing and future studies will continue to elucidate the true role for maintenance therapy options in patients with AML. Recent strategies, especially with hypomethylating agents have begun to show promise as maintenance therapy in improving clinical outcomes. Overall, the evidence in favor of maintenance therapy is limited. These approaches have included cytotoxic chemotherapy, immunotherapy, hypomethylating agents, and targeted small molecule therapy. For decades, investigators have attempted strategies of maintenance therapy to prolong both remission duration and overall survival in patients with AML. Despite these advances, even in patients that achieve a complete remission with initial therapy high rates of relapse remain a clinical dilemma. Recent advances in therapeutics coupled with steady improvements in supportive care for patients with acute myeloid leukemia (AML) have led to improved outcomes.
Physical Therapy treatments have been proved effective in many problems, such as continuous back pain, neck pain, headache, digestive problems, balance difficulties, whiplash and other collision injuries, occupational and sports injuries. Occupational therapists address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life.
Occupational therapy services are provided for the purpose of promoting health and wellness and are provided to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. An occupational therapist provides interventions based on evaluation and which emphasize the therapeutic use of everyday life activities (i.e., occupations) with individuals or groups for the purpose of facilitating participation in roles and situations and in home, school, workplace, community and other settings. Benchmark Pt Clinic An occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or predecessor organizations, or approved by the World Federation of Occupational Therapists (WFOT), or an equivalent international occupational therapy education program has successfully completed a period of supervised fieldwork experience required by the occupational therapy program has passed a nationally recognized entry-level examination for occupational therapists, and fulfills state requirements for licensure, certification, or registration.
0 kommentar(er)
