A modified Delphi consensus for the management of FLT3-mutated AML

A modified Delphi consensus on the management of patients with FLT3-mutated acute myeloid leukemia (AML), from a panel of eight Italian hematology experts, was recently published in Cancers by Olivieri et al. The aim of this consensus was to provide best practice recommendations for diagnosing and treating FLT3-mutated AML.

Key data: High consensus (≥80% agreement) was achieved across all statements in a single voting round. Key recommendations include testing for both FLT3-internal tandem duplication (ITD) and FLT3-tyrosine kinase domain (TKD) mutations at diagnosis, with capillary electrophoresis as the preferred method. All fit patients should receive intensive chemotherapy (IC) + an FLT3 inhibitor; additionally, all fit patients with FLT3‑ITD AML should be evaluated for allogeneic hematopoietic stem cell transplantation (allo‑HSCT) eligibility. Hypomethylating agent + venetoclax is considered suboptimal for unfit patients with FLT3‑ITD AML. Measurable residual disease (MRD) monitoring is recommended to guide transplant decisions. Retesting FLT3 is recommended for relapsed/refractory (R/R) disease, and gilteritinib is the preferred treatment option in this population.

Key learning: This consensus provides recommendations, based on clinical data, for mutation testing and therapeutic options for FLT3-mutated AML, supporting consistent management across institutions.