Bradley D Hunter1, Yi-Bin Chen2. 1. Blood and Marrow Transplant Program, Intermountain Healthcare, Salt Lake City, UT, USA. 2. Massachusetts General Hospital, 0 Emerson Place, Suite 118, Boston, MA, 02114, USA. ychen6@partners.org.
Abstract
PURPOSE OF REVIEW: This review discusses the current standard of care for incorporation of FLT3 TKIs and HCT into the treatment of FLT3-ITD AML. Additionally, this review provides an approach to the patient with relapsed/refractory disease. RECENT FINDINGS: Over the last decade, the routine use of HCT as consolidative therapy and the development of FLT3 TKIs have significantly improved remission rates and overall survival. The value and challenges of MRD assessment in FLT3 disease are discussed and current mechanisms of relapse are explored, as are the ongoing questions in the field that current clinical trials are seeking to answer. FLT3-ITD mutations are common in acute myeloid leukemia and historically have been associated with a poor prognosis, but with the incorporation of FLT3 TKIs and routine use of allogeneic stem cell transplant as consolidative therapy, outcomes have improved dramatically. Ongoing research seeks to answer how and when to best use current therapies, and how to overcome resistance to FLT3 inhibition.
PURPOSE OF REVIEW: This review discusses the current standard of care for incorporation of FLT3 TKIs and HCT into the treatment of FLT3-ITD AML. Additionally, this review provides an approach to the patient with relapsed/refractory disease. RECENT FINDINGS: Over the last decade, the routine use of HCT as consolidative therapy and the development of FLT3 TKIs have significantly improved remission rates and overall survival. The value and challenges of MRD assessment in FLT3 disease are discussed and current mechanisms of relapse are explored, as are the ongoing questions in the field that current clinical trials are seeking to answer. FLT3-ITD mutations are common in acute myeloid leukemia and historically have been associated with a poor prognosis, but with the incorporation of FLT3 TKIs and routine use of allogeneic stem cell transplant as consolidative therapy, outcomes have improved dramatically. Ongoing research seeks to answer how and when to best use current therapies, and how to overcome resistance to FLT3 inhibition.
Authors: R M Stone; T Fischer; R Paquette; G Schiller; C A Schiffer; G Ehninger; J Cortes; H M Kantarjian; D J DeAngelo; A Huntsman-Labed; C Dutreix; A del Corral; F Giles Journal: Leukemia Date: 2012-04-27 Impact factor: 11.528
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Authors: Yi-Bin Chen; Shuli Li; Andrew A Lane; Christine Connolly; Candice Del Rio; Betsy Valles; Morgan Curtis; Karen Ballen; Corey Cutler; Bimalangshu R Dey; Areej El-Jawahri; Amir T Fathi; Vincent T Ho; Amy Joyce; Steven McAfee; Michelle Rudek; Trivikram Rajkhowa; Sigitas Verselis; Joseph H Antin; Thomas R Spitzer; Mark Levis; Robert Soiffer Journal: Biol Blood Marrow Transplant Date: 2014-09-17 Impact factor: 5.742
Authors: Jorge E Cortes; Martin S Tallman; Gary J Schiller; Denise Trone; Guy Gammon; Stuart L Goldberg; Alexander E Perl; Jean-Pierre Marie; Giovanni Martinelli; Hagop M Kantarjian; Mark J Levis Journal: Blood Date: 2018-06-06 Impact factor: 22.113
Authors: Jay P Patel; Mithat Gönen; Maria E Figueroa; Hugo Fernandez; Zhuoxin Sun; Janis Racevskis; Pieter Van Vlierberghe; Igor Dolgalev; Sabrena Thomas; Olga Aminova; Kety Huberman; Janice Cheng; Agnes Viale; Nicholas D Socci; Adriana Heguy; Athena Cherry; Gail Vance; Rodney R Higgins; Rhett P Ketterling; Robert E Gallagher; Mark Litzow; Marcel R M van den Brink; Hillard M Lazarus; Jacob M Rowe; Selina Luger; Adolfo Ferrando; Elisabeth Paietta; Martin S Tallman; Ari Melnick; Omar Abdel-Wahab; Ross L Levine Journal: N Engl J Med Date: 2012-03-14 Impact factor: 91.245
Authors: Richard F Schlenk; Konstanze Döhner; Jürgen Krauter; Stefan Fröhling; Andrea Corbacioglu; Lars Bullinger; Marianne Habdank; Daniela Späth; Michael Morgan; Axel Benner; Brigitte Schlegelberger; Gerhard Heil; Arnold Ganser; Hartmut Döhner Journal: N Engl J Med Date: 2008-05-01 Impact factor: 91.245
Authors: Keith W Pratz; Michelle A Rudek; B Douglas Smith; Judith Karp; Ivana Gojo; Amy Dezern; Richard J Jones; Jackie Greer; Christopher Gocke; Maria R Baer; Vu H Duong; Gary Rosner; Marianna Zahurak; John J Wright; Ashkan Emadi; Mark Levis Journal: Biol Blood Marrow Transplant Date: 2019-09-21 Impact factor: 5.742
Authors: J How; J Sykes; M D Minden; V Gupta; K W L Yee; A D Schimmer; A C Schuh; S Kamel-Reid; J M Brandwein Journal: Blood Cancer J Date: 2013-05-24 Impact factor: 11.037