Targeted therapy for medullary and extramedullary relapse of FLT3-ITD acute myeloid leukemia following allogeneic hematopoietic stem cell transplantation

Abstract

We report a case with extramedullary tumors affecting the supraclavicular region that presented as a relapse of acute myeloid leukemia (AML) with FLT3-ITD mutation after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Treatment with gilteritinib resulted in remarkable response with disappearance of both the medullary and extramedullary tumors. Subsequently, a 2nd allo-HSCT was performed in an attempt to cure his AML and complete molecular response has been sustained with gilteritinib resumption without worsening GVHD. Targeted therapy with gilteritinib for medullary and extramedullary relapse of FLT3-ITD AML could be effective and suitable as a bridging therapy for allo-HSCT.

Therapeutic Management of Patients with FLT3 + Acute Myeloid Leukemia: Case Reports and Focus on Gilteritinib Monotherapy

“…Gilteritinib is also effective against extramedullary disease. 24 In fact, our 76 years old patient, who developed a rapid and massive progression of submandibular and laterocervical sarcoma with rapidly progressive inspiratory dyspnea and dysphagia, obtained the complete regression of the sarcomatous lesions after 4 months from the start of gilteritinib. Kida et al published the case of a 56-year-old man with FLT3-ITD mutated AML undergone to a myeloablative conditioning regimen, followed by peripheral blood stem cell transplantation.…”

A Relapsing Meningeal Acute Myeloid Leukaemia FLT3-ITD+ Responding to Gilteritinib

“…In addition, a rare adverse event of gilteritinib, manifesting in 0.6% of treated patients, is posterior reversible encephalopathy syndrome [4], which could represent a possible clue of its penetration into the BBB. We found only limited data about effective treatment with gilteritinib of extramedullary relapses as myeloid sarcoma [15, 16]. In particular, in the case reported by Kim et al [17], a patient with an iridociliochoroidal myeloid sarcoma responded to gilteritinib, a site where drug penetration may be reduced by the presence of the blood-retinal barrier [18].…”

Gilteritinib as treatment for extra-medullary relapse of FLT3-ITD acute myeloid leukemia FLT3-ITD, after allogeneic haematopoietic stem cell transplantation

“…After 3 months of Gilteritinib, bone marrow aspiration confirmed morphological CR, full donor chimerism (99.96%), in absence of NPM1positivity. Reduction of breast nodules was documented by breast ultrasound and PET-CT [ 2 , 3 ].…”

“…Currently, new target therapies are available for these patients, such as the oral selective FLT3 inhibitor Gilteritinb, currently approved for the treatment of adults with relapsed/refractory FLT3 AML as well as Midostaurin for newly diagnosed patients in combination with chemotherapy [1] . Recurrence of AML can also occur at extramedullary level potentially involving different organs and most frequent localization is the skin, with cumulative incidence of 5–12% [ 1 , 2 ].…”

“…Currently, few cases [ 1 , 2 , 3 ] of extramedullary relapse of AML FLT3 treated with FLT3 inhibitors are reported, in particular after the first or second allogeneic HSCT [ 3 , 4 , 5 ]. We report here the case of a FLT3 AML patient with bone marrow and mammary extramedullary relapse, after 1 st and 2 nd allogeneic HSCT, respectively, and successfully treated with Gilteritenib in both cases.…”