Core Binding Factor Leukemia and the Continuing Role of Intensive Chemotherapy in AML

This segment describes a foundational point in AML management: despite rapid advancements in lower-intensity therapies, intensive chemotherapy remains essential for certain biologically favorable AML subsets. The panel emphasizes that the emergence of triplet combinations and evolving venetoclax-based approaches should not obscure the fact that some forms of AML are highly curable with established intensive regimens.

The discussion highlights core binding factor (CBF) leukemias, characterized by t(8;21) and inv(16), as prime examples. These patients historically demonstrate excellent long-term outcomes with intensive cytarabine-based induction and consolidation. The experts caution that, despite enthusiasm for newer therapies, there is no current evidence supporting the replacement of intensive chemotherapy in these settings. The goal must remain cure, and altering curative approaches without proof from randomized data risks undermining decades of progress.

They extend this reasoning to other molecularly favorable groups, such as NPM1-mutated AML with normal cytogenetics. Although newer strategies may someday prove effective enough to replace intensive therapy, the current standard of care remains intensive induction followed by risk-adapted consolidation or transplant, depending on MRD evolution and emerging risk features.

Panelists also reiterate that low-intensity induction strategies, such as azacitidine–venetoclax, should not be interpreted as “7+3 replacements.” They note that although these regimens achieve deep remissions in many patients, their role as curative therapies in younger, fit individuals remains unproven. Small clinical experiences described by the panel show that severely shortening venetoclax duration or using it as a 7-day monotherapy induction does not reliably replicate the outcomes of established intensive chemotherapy.

Although innovation continues, clinicians must protect curative therapies in patients most likely to benefit from them.