FLT3 Inhibitors As Maintenance Therapy Post Allogenic Hematopoietic Stem Cell Transplantation in Acute Myeloid Leukemia Patients with FLT3 Mutations; A Systematic Review and Meta-Analysis

Ansar, Sadia

Oral and Poster Abstracts
908. Outcomes Research: Myeloid Malignancies: Poster III

Research, Acute Myeloid Malignancies, AML, Adult, Elderly, Clinical Research, Diseases, Treatment Considerations, Myeloid Malignancies, Study Population, Human

Sadia Ansar¹^*, Mahnoor Asghar Keen, MD, MBBS²^*, Mahnoor Sukaina, MBBS³^*, Muhammad Saeed, MBBS⁴^*, Zarlish Rehman, MD, MBBS²^*, Roshaan Rehman, MBBS⁵^*, Qazi Muhammad Farooq Wahab, MD, MBBS²^*, Faryal Masaud, MBBS²^*, Aqsa Mumtaz, MD, MBBS⁶^*, Karan Jatwani, MD, MBBS⁷^* and Muhammad Salman Faisal, MD, MBBS⁸

¹Rawal Institute of Health Sciences, Islamabad, Pakistan
²Khyber Medical College, Peshawar, Pakistan
³Karachi Medical and Dental College, Karachi, Pakistan
⁴D.G. Khan Medical College, Dera Ghazi Khan, Pakistan
⁵Kabir Medical College, Peshawar, Pakistan
⁶Montefiore St. Luke's Cornwall, Newburgh, NY
⁷Assistant Professor, Department of Hematology Oncology, George Washington University, Washington DC
⁸University of Oklahoma Stephenson Cancer Center, Oklahoma City, OK

INTRODUCTION:

Approximately 20-30% of adult patients with acute myeloid leukemia (AML) have an FMS-like tyrosine kinase 3 (FLT3) mutation, which falls in the intermediate risk category for relapse and overall survival per ELN 2022 classification, and eligible patients undergo allogeneic hematopoietic cell transplantation (allo-HCT). FLT3 inhibitors (FLT3i) are used in induction and relapsed settings, but recent studies suggest that FLT3i may reduce the risk of post-transplant relapse. We performed this systematic review and meta-analysis to evaluate the efficacy of FLT3i as post-transplant maintenance therapy in AML patients.

METHODS:

A comprehensive search was conducted across PubMed, Embase, Cochrane Library, and Clinicaltrials.gov from inception to March 29, 2024. Studies were included that evaluated response [overall survival (OS), relapse-free survival (RFS), and leukemia-free survival (LFS)], in comparisons between FLT3i and control groups. RevMan version 5.4.1 was used for statistical analysis. A random effect model with inverse variance as the statistical method was used for hazard ratio (HR) and 95% confidence interval (CI).

RESULTS:

Of 1698 included studies, the data consists of 13 observational studies, comprising 4402 patients (52% males and 48% females), who met the inclusion criteria. Of the sample size, 36% of patients received FLT3i therapy, while the control group comprised 63.9% of patients. Patient age ranged from 14 to 78 years (median 49 years in intervention). AML subtypes included de novo (29%), secondary to antecedent hematological disorder (AHD) (1.7%), secondary to therapy (0.8%), and unspecified (68.5%). The follow-up period extended from 5.7 to 47.7 months. Nine out of thirteen studies reported cytogenetic risk. The type of FLT3i regimen used was reported as 54% Sorafenib followed by 15% Midostaurin, and only 8% Gilteritinib and Quizartinib. FLTi as maintenance in post-transplant patients significantly improved OS [ HR; 0.56] 95% CI [0.46-0.68], P< 0.00001, I² 31%], RFS [HR 0.56; 95% CI (0.50-0.64), P< 0.00001, I² 0%] and LFS [HR 0.47; 95% CI (0.38-0.57), P< 0.00001, I² 0%] as compared to control.

CONCLUSION:

This meta-analysis demonstrates the efficacy of FLT3i as a post-transplant maintenance therapy for preventing relapse in AML patients.

Disclosures: No relevant conflicts of interest to declare.

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5197 FLT3 Inhibitors As Maintenance Therapy Post Allogenic Hematopoietic Stem Cell Transplantation in Acute Myeloid Leukemia Patients with FLT3 Mutations; A Systematic Review and Meta-Analysis