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Posted by on May 18, 2021 in Leukemia | 0 comments

In a nutshell

This study aimed to review existing evidence regarding the outcome of tyrosine kinase inhibitor (TKI) maintenance therapy after allogeneic stem-cell transplantation (allo-SCT) in patients with FLT3-ITD mutated (genetic abnormality) acute myeloid leukemia (AML).  

This study concluded that TKI maintenance therapy after allo-SCT was associated with improved outcomes and survival for these patients.  

Some background

AML that results from the FLT3-ITD mutation is an aggressive form of leukemia. Patients with this condition have a poorer prognosis when treated with standard therapies. One treatment option for these patients is allo-SCT. This involves transplanting stem cells (cells that can develop into any cells of the body) from a donor (commonly a sibling). However, many patients relapse after allo-SCT.

After a powerful treatment, patients can receive maintenance treatment to prevent relapse. TKIs such as sorafenib (Nexavar) and midostaurin (Rydapt) are a type of targeted therapy that shows promise in patients with relapsed FLT3-ITD mutated AML. However, it is not clear if TKI maintenance after allo-SCT in patients with AML with an FLT3-ITD mutation is effective.  

Methods & findings

This study analyzed data from 7 studies that included 680 patients with FLT3-ITD mutated AML. All patients had a stem cell transplant followed by TKI maintenance. Five studies used sorafenib as TKI treatment after stem cell transplant and two used midostaurin. The follow-up ranged between 18 and 59 months. 

Survival without relapse was 52% higher in patients that had TKI maintenance compared to those who did not. Relapse was 65% less likely in patients treated with TKI maintenance.   and overall survival were significantly improved after TKI maintenance therapy. There was no significant difference between sorafenib and midostaurin treatment.  

Patients treated with TKI maintenance were also 52% more likely to survive compared to those who did not. 

The bottom line

This study concluded that maintenance therapy with TKI after allo-SCT was associated with improved outcomes for patients with FLT3-ITD mutated AML.  

The fine print

The studies analyzed had different protocols. The chemotherapy used before allo-SCT was not the same. Also, the time from transplant TKI was started was not the same. This may have influenced the results.

Published By :

Frontiers in immunology

Date :

Apr 02, 2021

Original Title :

TKI Maintenance After Stem-Cell Transplantation for FLT3-ITD Positive Acute Myeloid Leukemia: A Systematic Review and Meta-Analysis.

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