Midostaurin in combination with intensive chemotherapy is safe and associated with improved remission rates and higher transplantation rates in first remission—a multi-center historical control study

Tamar Berger, Uri Rozovski, Yakir Moshe, Shilo Yaari, Avraham Frisch, Ilana Hellmann, Arie Apel, Adina Aviram, Maya Koren-Michowitz, Moshe Yeshurun, Ron Ram, Pia Raanani, Yishai Ofran, Ofir Wolach*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

The addition of midostaurin, a FLT3-inhibitor, to intensive chemotherapy (IC) was previously shown to improve outcome of younger patients with FLT3-mutated AML. The toxicity and efficacy of adding midostaurin to IC in patients not originally included in the RATIFY study or with intensified daunorubicin dosing are unknown. We conducted a retrospective, multi-center, historical-control study to characterize the safety and efficacy of adding midostaurin to IC in a “real-world” setting. Sixty-nine adult patients were included in the analysis (midostaurin n = 34, historical controls n = 35) with a mean follow-up of 18.4 (± 15) months. Median age of patients was 60 (range 26–82) years; 32% and 20% of patients were > 65 and 70 years, respectively. No differences in baseline characteristics were noted between the groups. Midostaurin was administered with 90 mg/m2 daunorubicin in 29% of patients; One-third of patients experienced dose reductions/interruptions during midostaurin therapy. Overall toxicity was comparable between the midostaurin and control groups.CR/CRi rates were higher in patients treated with midostaurin compared with controls (80% vs. 57%, p = 0.047) and significantly more patients in the midostaurin group were transplanted in first remission (95% vs. 68%, p = 0.04).Median OS and DFS were higher in the midostaurin vs. control group (not reached vs. 11 months (p = 0.085) and 13 vs. 6 months (p = 0.09), respectively). In our analysis, midostaurin was not associated with increased toxicity including in older patients, in those with secondary AML or when administered with intensified daunorubicin dosage. Higher remission rates in the midostaurin group and increased transplantation rates in first CR were associated with a trend towards better outcomes.

Original languageEnglish
Pages (from-to)2711-2717
Number of pages7
JournalAnnals of Hematology
Volume98
Issue number12
DOIs
StatePublished - 1 Dec 2019

Keywords

  • Acute myeloid leukemia
  • FLT3 mutation
  • Midostaurin

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