In older/unfit newly diagnosed patients with FLT3 mutated acute myeloid leukemia (AML), lower intensity chemotherapy (LIC) in combination with either a FLT3 inhibitor or with venetoclax results in poor overall survival (median 8 to 12.5 months). We performed a retrospective analysis of 87 newly diagnosed FLT3 mutated AML patients treated on triplet (LIC + FLT3 inhibitor + Venetoclax, [N = 27]) and doublet (LIC + FLT3 inhibitor, [N = 60]) regimens at our institution. Data were collected from prospective clinical trials in 75% (N = 65) and 25% (N = 22) who received the same treatment regimens outside of a clinical trial. Triplet therapy was associated with significantly higher rates of complete remission (CR) (67% versus 32%, P = 0.002), CR/CRi (93% versus 70%, P = 0.02), FLT3-PCR negativity (96% versus 54%, P < 0.01), and flow-cytometry negativity (83% versus 38%, P < 0.01) than doublets. At the end of the first cycle, the median time to ANC > 0.5 (40 versus 21 days, P = 0.15) and platelet > 50 K (29 versus 25 days, P = 0.6) among responders was numerically longer with triplets, but 60-day mortality was similar (7% v 10%). With a median follow-up of 24 months (median 12 months for triplet arm, and 63 months for doublet arm), patients receiving a triplet regimen had a longer median overall survival (not reached versus 9.5 months, P < 0.01). LIC combined with FLT3 inhibitor and venetoclax (triplet) may be an effective frontline regimen for older/unfit FLT3 mutated AML that should be further validated prospectively.

在年龄较大/身体不适的新诊断FLT3突变急性髓性白血病 (AML) 患者中，低强度化疗 (LIC) 联合 FLT3 抑制剂或维奈托克导致总生存期较差（中位 8 至 12.5 个月）。我们对在我们机构接受三药（LIC + FLT3 抑制剂 + Venetoclax，[ N  = 27]）和双药（LIC + FLT3 抑制剂，[ N  = 60]）方案治疗的 87 名新诊断的FLT3突变 AML 患者进行了回顾性分析。75% ( N  = 65) 和 25% ( N = 22) 在临床试验之外接受相同治疗方案的人。三联疗法与显着更高的完全缓解率 (CR)（67% 对 32%，P  = 0.002）、CR/CRi（93% 对 70%，P  = 0.02）、FLT3-PCR 阴性率（96% 对 54 %，P  < 0.01）和流式细胞术阴性（83% 对 38%，P  < 0.01）。在第一个周期结束时，ANC > 0.5（40 天对 21 天，P  = 0.15）和血小板 > 50 K（29 天对 25 天，P = 0.6) 三胞胎的反应者在数值上更长，但 60 天死亡率相似 (7% 对 10%)。中位随访 24 个月（三联组中位随访 12 个月，双联组中位随访 63 个月），接受三联方案的患者的中位总生存期更长（未达到 9.5 个月，P  < 0.01）。LIC 联合 FLT3 抑制剂和维奈托克（三联）可能是治疗老年/不适应FLT3突变 AML 的有效一线方案，应进一步前瞻性验证。