TY - JOUR
T1 - Salvage therapy using FLT3 inhibitors may improve long-term outcome of relapsed or refractory AML in patients with FLT3-ITD
AU - Takahashi, Koichi
AU - Kantarjian, Hagop
AU - Pemmaraju, Naveen
AU - Andreeff, Michael
AU - Borthakur, Gautam
AU - Faderl, Stefan
AU - Garcia-Manero, Guillermo
AU - Pierce, Sherry
AU - Luthra, Rajyalakshmi
AU - Cardenas-Turanzas, Marylou
AU - Estrov, Zeev
AU - Ravandi, Farhad
AU - Cortes, Jorge
PY - 2013/6
Y1 - 2013/6
N2 - To determine the long-term efficacy of FLT3 inhibitors (FLT3i) in the salvage setting for relapsed and refractory (rel/ref) acute myeloid leukemia (AML) with FLT3 internal tandem duplication (AML FLT3-ITD), we conducted a retrospective study of 120 patients with rel/ref AML FLT3-ITD who received salvage therapy with either FLT3i-containing regimen (FLT3i group, N = 45) or conventional cytotoxic regimen (conventional group, N = 75). The median overall survival (OS) after the first salvage in the FLT3i group was 6·9 vs. 4·6 months in the conventional group (P = 0·17). The OS was better in the FLT3i group among patients with initial complete remission (CR) duration ≤12 months or with primary refractory disease (6·9 vs. 3·7 months; P < 0·01). The OS was better when FLT3i was combined with cytotoxic agents versus monotherapy (17 vs. 4·8 months; P = 0·017). Multivariate analysis revealed that the use of FLT3i was an independent predictor of OS (hazard ratio 0·58; 95% confidence interval, 0·38-0·88). Incorporating FLT3i into salvage strategies may improve long-term outcome of patients with AML FLT3-ITD. Prospective studies to validate this conclusion are warranted.
AB - To determine the long-term efficacy of FLT3 inhibitors (FLT3i) in the salvage setting for relapsed and refractory (rel/ref) acute myeloid leukemia (AML) with FLT3 internal tandem duplication (AML FLT3-ITD), we conducted a retrospective study of 120 patients with rel/ref AML FLT3-ITD who received salvage therapy with either FLT3i-containing regimen (FLT3i group, N = 45) or conventional cytotoxic regimen (conventional group, N = 75). The median overall survival (OS) after the first salvage in the FLT3i group was 6·9 vs. 4·6 months in the conventional group (P = 0·17). The OS was better in the FLT3i group among patients with initial complete remission (CR) duration ≤12 months or with primary refractory disease (6·9 vs. 3·7 months; P < 0·01). The OS was better when FLT3i was combined with cytotoxic agents versus monotherapy (17 vs. 4·8 months; P = 0·017). Multivariate analysis revealed that the use of FLT3i was an independent predictor of OS (hazard ratio 0·58; 95% confidence interval, 0·38-0·88). Incorporating FLT3i into salvage strategies may improve long-term outcome of patients with AML FLT3-ITD. Prospective studies to validate this conclusion are warranted.
KW - Acute myeloid leukemia
KW - FLT3 inhibitors
KW - FLT3-ITD
UR - http://www.scopus.com/inward/record.url?scp=84877795436&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84877795436&partnerID=8YFLogxK
U2 - 10.1111/bjh.12299
DO - 10.1111/bjh.12299
M3 - Article
C2 - 23530930
AN - SCOPUS:84877795436
SN - 0007-1048
VL - 161
SP - 659
EP - 666
JO - British Journal of Haematology
JF - British Journal of Haematology
IS - 5
ER -