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SOHO 2024 | The use of gilteritinib in post-transplant maintenance for AML with FLT3-ITD
Mark Levis, MD, PhD, John Hopkins University, Baltimore, MD, highlights the favorable tolerability of gilteritinib compared to other FLT3 inhibitors in the post-transplant setting for acute myeloid leukemia (AML). Dr Levis also emphasizes that FLT3 inhibitors are not always necessary in patients who are measurable residual disease (MRD)-negative pre-transplant. This interview took place at the Twelfth Annual Meeting of the Society of Hematologic Oncology (SOHO 2024) congress in Houston, TX.
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Transcript
So in the US, this is, I would argue, probably the standard of care right now, even though it is not on label. Gilteritinib is easily the best tolerated drug in the post-transplant setting. Patients don’t mind taking it and we have data out of the MORPHO trial where we can identify the patients who need it, which is about half of all patients going into transplant. So it’s important to know the MRD status prior to transplant so that you know whether you have to use a FLT3 inhibitor...
So in the US, this is, I would argue, probably the standard of care right now, even though it is not on label. Gilteritinib is easily the best tolerated drug in the post-transplant setting. Patients don’t mind taking it and we have data out of the MORPHO trial where we can identify the patients who need it, which is about half of all patients going into transplant. So it’s important to know the MRD status prior to transplant so that you know whether you have to use a FLT3 inhibitor. You don’t want to. FLT3 inhibitors cause all manner of problems after transplant- they exacerbate graft-versus-host disease, they increase the risk of infection, they interact with other drugs. You only want to use it when you have to. And so if you’re managing a patient after transplant, it’s a tremendous advantage to know that you don’t have to use a FLT3 inhibitor if they were MRD negative going in, it really frees up what you can do. Whereas if you know they were MRD positive, you know you have to work to get the patient on the FLT3 inhibitor, and that may mean altering their other pharmacologic therapy or whatever it takes. But knowledge is key there. Having the knowledge that you have to or don’t have to use it is important.
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