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- Title
Real-Life Management of FLT3-Mutated AML: Single-Centre Experience over 24 Years.
- Authors
Capria, Saveria; Trisolini, Silvia Maria; Torrieri, Lorenzo; Amabile, Elena; Marsili, Giovanni; Piciocchi, Alfonso; Barberi, Walter; Iori, Anna Paola; Diverio, Daniela; Carmini, Daniela; Breccia, Massimo; Martelli, Maurizio; Minotti, Clara
- Abstract
Simple Summary: FLT3 mutations are common in acute myeloid leukemia (AML) and are often associated with poorer outcomes and higher relapse rates. This study examined the long-term outcomes of FLT3-mutated (FLT3m) AML patients who received intensive treatment at our institution over the past 24 years, comparing the results in patients who received standard chemotherapy alone with those who received a FLT3 inhibitor (FLT3i). Our single-center, real-life experience confirms the impact of FLT3i administration on survival, both in frontline and salvage settings. In addition, our results underline that the proper positioning of allogeneic stem cell transplantation in the therapeutic algorithm is still an unmet need. These findings suggest that incorporating FLT3-targeting agents into treatment plans may improve outcomes for AML patients while highlighting the need for the continued optimization of treatment strategies to enhance patient survival and quality of life. We analyzed 140 patients with a median age of 51 years; 21% had WBC ≥ 100 × 109/L, and 52% had an NPM1 co-mutation. Until 2018, 101 patients received chemotherapy; thereafter, 39 received 3+7+midostaurin. The overall CR rate was 64%, higher in NPM1 mutant patients (73%). Univariate analysis showed that NPM1 mutation (p = 0.032) and WBC < 100 × 109/L (p = 0.013) positively influenced the response, with a trend for FLT3i administration (p = 0.052). Multivariate analysis confirmed WBC count as an independent prognostic factor (p = 0.017). In CR1, 41/90 patients underwent allogeneic and 18 autologous transplantation. The median EFS was 1.1 vs. 1.6 years in autografted and allografted patients, respectively (p = 0.9). The one-year non-relapse mortality was 0.00% for autologous and 28% for allogeneic transplants (p = 0.007); CIR at 1 and 3 years was higher in autologous transplants (39% vs. 15% and 57% vs. 21%, p = 0.004). The median survival was not reached in the FLT3i group. Overall, 69 patients received stem cell transplantation (18 autologous, 51 allogeneic). Post-transplant FLT3i was resumed in eight patients, all alive after a median of 65 months. Allogeneic transplantation is crucial in FLT3-mutated AML, but the next challenge will be to identify which patients can benefit from transplants in CR1 and in which to intensify post-transplant therapy.
- Subjects
LEUCOCYTES; HEMATOPOIETIC stem cell transplantation; PROTEIN-tyrosine kinase inhibitors; TREATMENT effectiveness; DESCRIPTIVE statistics; MULTIVARIATE analysis; CANCER chemotherapy; STATISTICS; GENETIC mutation
- Publication
Cancers, 2024, Vol 16, Issue 16, p2864
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16162864