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HMA + venetoclax + FLT3 inhibitor in FLT3-mutated AML: Long-term outcomes
Results from a retrospective analysis of 73 patients with newly diagnosed FLT3-mutated acute myeloid leukemia (AML), treated in prospective clinical trials with a frontline hypomethylating agent (HMA), venetoclax, and a FLT3 inhibitor, were recently published in Haematologica by Short et al.
Key data: The composite complete remission (CR) and CR with incomplete hematologic recovery (CRi) rate was 93%. The estimated 3-year relapse-free survival (RFS) for FLT3-internal tandem duplication (ITD)-mutated and FLT3-tyrosine kinase domain (TKD)-mutated AML were 38% and 76%, respectively, with 3-year overall survival (OS) rates of 45% and 76%, respectively. Baseline RAS pathway mutations were associated with poor long-term survival (3-year OS 22% vs 63% without RAS pathway mutation; p = 0.07). FLT3 wild type relapses accounted for 65% of relapses.
Key learning: Triplet combinations of an HMA, venetoclax, and an FLT3 inhibitor result in durable remission and encouraging long-term OS in older adults with newly diagnosed FLT3-mutated AML. However, better strategies to prevent FLT3 wild type relapses and overcome RAS pathway-mediated resistance are still needed.
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