Table 4.

Novel Strategies for the Treatment of Adult AML

Agent	Target/Class	Comment
Fludarabine	Nucleoside analog	When used first line in the FLAG-Ida regimen, has been shown to be more effective than standard induction chemotherapy
Cladribine	Nucleoside analog	When added to 3+7 during induction, improved survival compared to 3+7 alone
Clofarabine	Nucleoside analog	Improves outcome when added to IA in patients younger than 40 yr
Gemtuzumab	Monoclonal antibody	Improves survival in subsets of younger and older patients when added to chemotherapy
Decitabine	Hypomethylating agent	Decitabine is approved in Europe in elderly patients based on improved survival compared to standard treatment; Extending the regimen to 10 days is a promising strategy; used prior to standard chemotherapy as epigenetic “priming” is an innovative approach
CPX-351	Liposomal formulation of cytarabine and daunorubicin	High response rates noted in phase II trials, particularly in patients with secondary AML; also being studied in the salvage setting
Omacetaxine	Protein synthesis inhibitor	Improved outcomes in patients with favorable or intermediate cytogenetics compared to 7+3
FLT3 Inhibitors	Tyrosine kinase Inhibitors	Several promising oral agents being studied alone or in combination with chemotherapy or hypomethylating agents (midostaurin, sorafenib, quizartinib, crenolanib)
Vosaroxin	DNA intercalating agent, topoisomerase II inhibitor	Large, phase III study ongoing comparing moderate dose cytarabine with or without vosaroxin for relapsed AML