SPECIAL ARTICLE  ACUTE LEUKEMIAS IN 2020: STATE OF THE ART Free access

Minerva Medica 2020 October;111(5):443-54

DOI: 10.23736/S0026-4806.20.07014-7

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Midostaurin in acute myeloid leukemia: current evidence and practical considerations in routine clinical use

Nurul A. ABDUL-HAMIL ¹ ✉, Gee C. WONG ^{1, 2}, Chandramouli NAGARAJAN ^{1, 2}, Giovanni MARTINELLI ³, Claudio CHERCHIONE ³

¹ Department of Hematology, Singapore General Hospital, Singapore, Singapore; ² SingHealth Duke-NUS Blood Cancer Center, Singapore, Singapore; ³ Unit of Hematology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy

Mutation within the FMS-like tyrosine kinase 3 (FLT3) gene are one of the most frequent genetic alterations in acute myeloid leukemia. A high mutation fraction of FLT3-ITD molecules on the surface of leukemia cells is associated with short remissions and overall adverse outcomes in AML. In this article we summarize the clinical trial data of midostaurin - one of the FLT3 inhibitors. We review its use in various combinations both in relapsed/refractory acute myeloid leukemia as well as in the newly diagnosed patients and recollect the evidence of its use as maintenance therapy post allogenic stem cell transplantation. We enumerate the practical issues faced in the use of midostaurin like antifungal prophylaxis, dosage of concomitant chemotherapy agents as well as available data on sequencing of the FLT3 inhibitors. Lastly, we provide our perspective of the future directions for FLT3 inhibition especially midostaurin, the underlying resistance mechanisms and the need for standardization of the FLT3 tests.

KEY WORDS: Leukemia, myeloid, acute; Antagonists and inhibitors; Midostaurin