Key clinical point: Independent of transplant method, quizartinib improved survival vs, salvage chemotherapy for patients with refractory/relapsed acute myeloid leukemia.

Major finding: Median overall survival was 6.2 vs. 4.7 months [HR, 0.76;P = .02) for quizartinib vs. salvage chemotherapy respectively.

Study details: Of 367 randomized patients, 85 in the quizartinib arm underwent any subsequent HSCT and 84 underwent autologous HSCT; 19 patients in the SC arm underwent any HSCT.

Disclosures: No funding or conflicts information was provided.

Commentary

“It is generally expected that HSCT in complete remission would provide some clinical benefit in selected patients with FLT3 mutated R/R AML, particularly if they have not been transplanted before. The finding that the median survival of patients who underwent HSCT was similar in both arms is testament to this. Strategies that increase the rates of CR would be beneficial in to allow more patients to go on to transplant.

More importantly, these findings raise another important concept of post HSCT FLT3 maintenance therapy to improve survival post-transplant which is increasingly being studied and already in practice in many institutions. More importantly, the current landscape of R/R FLT3+ AML is changing with universal exposure to FLT3 inhibitors (midostaurin) in the front-line setting. This needs to be taken into account while interpreting results of novel FLT3 agents in R/R AML.”

Pinkal Desai, MD, MPH

Weill Cornell Medicine