A triplet therapy consisting of lower-intensity chemotherapy, specifically monotherapy with a hypomethylating agent (HMA), combined with an FLT3 inhibitor and venetoclax may be an effective frontline regimen for older or unfit patients with FLT3-mutated acute myeloid leukemia (AML), according to a retrospective analysis.
The results were published in Blood Cancer Journal in a paper by Musa Yilmaz, MD, of The University of Texas MD Anderson Cancer Center, and colleagues.
The study included 87 newly diagnosed patients with FLT3-mutated AML treated on the triplet (n=27) and doublet lower-intensity chemotherapy plus FLT3 inhibitor (n=60) regimens.
Triplet therapy was associated with significantly higher rates of complete remission (CR; 67% vs 32%; P=.002), CR/CR with incomplete hematologic recovery (93% vs 70%, P=.02), FLT3-polymerase chain reaction negativity (96% vs 54%; P<.01), and flow cytometry negativity (83% vs 38%; P<.01) compared with doublets.
At the end of the first cycle, the median time to absolute neutrophil count >0.5 (40 vs 21 days; P=.15) and platelet >50,000 (29 vs 25 days; P=.6) among responders was numerically longer with triplets, but 60-day mortality was similar (7% vs 10%). With a median follow-up of 24 months (median, 12 months for triplet arm and 63 months for doublet arm), patients receiving a triplet regimen had a longer median overall survival (not reached vs 9.5 months; P<.01).
“[Lower-intensity chemotherapy] combined with [an] FLT3 inhibitor and venetoclax (triplet) may be an effective frontline regimen for older/unfit FLT3-mutated AML that should be further validated prospectively,” the authors concluded.
Reference
Yilmaz M, Kantarjian H, Short NJ, et al. Hypomethylating agent and venetoclax with FLT3 inhibitor “triplet” therapy in older/unfit patients with FLT3 mutated AML. Blood Cancer J. 2022;12(5):77. doi:10.1038/s41408-022-00670-0
