In this episode of the Oncology Brothers podcast, Drs. Rahul & Rohit Gosain, dived into the complexities of relapsed refractory acute myeloid leukemia (AML) with FLT3 mutations. We are joined by esteemed leukemia specialists Dr. Uma Borate from the Ohio State University and Dr. Naval Daver from the MD Anderson Cancer Center, who share their insights on current treatment paradigms and case management strategies.
We began by discussing the standard of care for leukemia patients, emphasized the importance of distinguishing between fit and unfit patients. For fit patients, the treatment typically involves a 7 plus 3 induction regimen with Midostaurin or Quizartinib, followed by transplant or maintenance therapy. In contrast, unfit patients usually receive hypomethylating agents (HMA) combined with venetoclax.
Our first case featured a 47-year-old woman who relapsed 14 months post-transplant. Dr. Daver highlighted the necessity of retesting for FLT3 mutations at relapse, as patients can lose the mutation after intensive chemotherapy. He advocated for the use of Gilteritinib as the approved option for relapsed FLT3-mutated AML, with a preference for combination therapies to enhance response rates.
Dr. Borate added that while Gilteritinib monotherapy is effective, combining it with venetoclax can lead to quicker disease control, albeit with the risk of profound cytopenias. We also discussed the side effects associated with Gilteritinib, including QTc prolongation and transaminitis the importance of monitoring these in clinical practice.
In our second case, we explored treatment options for an 80-year-old patient with FLT3 TKD positive AML who is unfit for induction. Both experts agree that starting with azacitidine and venetoclax is reasonable, and if the patient relapsed, Gilteritinib monotherapy or a combination with venetoclax may be appropriate.
Throughout the episode, we emphasized the significance of supportive care, including prophylactic antibiotics, and the evolving landscape of oral therapies in AML treatment. We concluded by reiterating the importance of retesting for mutations at relapse and staying informed about the latest treatment strategies.
