Blood and Lymphatic Cancer: Targets and Therapy (Sep 2022)
FLT3 Inhibitors as Maintenance Therapy after Allogeneic Stem-Cell Transplantation
Abstract
Amanda Blackmon,* Ibrahim Aldoss,* Brian J Ball* Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA*These authors contributed equally to this workCorrespondence: Brian J Ball, Division of Leukemia, Department of Hematology and HCT, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA, Email [email protected]: Mutations in the FLT3 gene are associated with poor prognosis in patients with AML, even after consolidation with allogeneic hematopoietic cell transplantation (alloHCT) in first remission. Treatment failure in FLT3-mutated AML is largely driven by excessive risk of relapse compared to other genetic subtypes, including in patients post-alloHCT. As a result, there is substantial interest in studying posttransplant maintenance therapy in FLT3-mutated AML as an approach to optimize disease control and improve long-term outcomes. Clinical trials utilizing posttransplant FLT3 inhibitors, such as sorafenib and midostaurin, have shown feasibility, safety, and encouraging posttransplant outcomes, and there are ongoing studies using newer-generation tyrosine-kinase inhibitors as posttransplant maintenance therapy. Here, we review the toxicities and efficacy of FLT3 inhibitors as posttransplant maintenance, recommendations on the use of FLT3 inhibitors by international consensus guidelines, and highlight key remaining questions.Keywords: FLT3 inhibitor, posttransplantation, maintenance, stem-cell transplantation, midostaurin, sorafenib
