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Baskarane, Hemavathi; Sahoo, Ranjit Kumar
Clinical lymphoma, myeloma and leukemia, September 2023, 2023-09-00, Volume: 23Journal Article
FLT3-ITD-mutated AML, which occurs in the juxta membrane domain of the FLT3 gene, is reported in 25%–30% of patients and it is associated with inferior outcomes and early relapse. Although transplant remains the treatment of choice, FLT3 inhibition in addition to induction chemotherapy has shown to have effect on survival outcomes. Overall induction mortality was reported to range from 7% to 40% from various centers across India. We explored the effect of low-intensity triplet therapy as an induction regimen in FLT3-ITD-mutated AML. Patients received A cumulative dosage of azacytidine 75 mg/m2 subcutaneously daily for 7 days and dosed at 100 mg daily. Venetoclax and sorafenib were also given for similar duration of azacytidine with venetoclax at the dose of 50 mg per day with azole and sorafenib at the dose of 200 mg per day. Patients were started on induction after adequate cytoreduction. Cycles were repeated at monthly intervals. We retrospectively analyzed 7 patients who have received this combination regimen from June 2022 to April 2023 and herein report the outcomes of Cycle 1 induction. Median age was 39 years (33 to 59). Out of 7 patients, 3 had diabetes and 1 had hypertension. A next-generation sequencing report was available for 4 patients. Co-mutations detected were NPM1 in 3, IDH2R140 in 2 and EZH2 in 1 patient. Median duration of venetoclax and sorafenib was 8 days. Out of 7 patients, 6 had febrile neutropenia and 2 required hospitalization. Median absolute neutrophil count recovery time was 28 days. All 7 patients had complete remission. Minimal residual disease assessment was available for 6 patients and was negative in 4 of them. Triple therapy with azacytidine and venetoclax with sorafenib for limited duration causes adequate myelosuppression and remains a feasible induction option in FLT3-ITD-mutated AML as a bridge to transplant.
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