Impact of FMS-like tyrosine kinase 3 inhibitor maintenance on post-transplant outcomes in acute myeloid leukemia with FMS-like tyrosine kinase 3 mutations: a real-world German registry analysis highli
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- #AML
- #post-transplant maintenance
- #FLT3 inhibitors
- FLT3 mutations occur in 25-30% of AML cases, leading to high relapse risk and inferior survival.
- Allogeneic hematopoietic cell transplantation (allo-HCT) is a curative option, but relapse remains a major challenge post-transplant.
- FLT3 inhibitor (FLT3i) maintenance therapy post-allo-HCT shows promise, with real-world evidence being limited.
- The study analyzed 523 adults with FLT3-ITD AML in first complete remission who underwent allo-HCT between 2011 and 2023 in Germany.
- 22% of patients received FLT3i maintenance (sorafenib 49%, midostaurin 37%, gilteritinib 5%, unknown 9%).
- Multivariable analyses showed FLT3i maintenance improved OS, RFS, non-relapse mortality, and GVHD- and relapse-free survival.
- Sorafenib maintenance demonstrated superior efficacy with 5-year OS of 85% versus 62% and RFS of 84% versus 55% compared to no maintenance.
- The study supports FLT3i maintenance as part of post-transplant care for FLT3-ITD AML, despite limitations like retrospective design and potential selection bias.