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Durable remission of post-transplant relapsed FLT3-ITD AML in response to gilteritinib administration after a second transplant from the same donor

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Abstract

Patients with FMS-like tyrosine kinase 3 internal tandem duplication (FLT3-ITD) acute myeloid leukemia (AML) respond to conventional induction chemotherapy, with remission rates similar to those seen in other subtypes; however, they are much more likely to relapse and relapse is rapid. For this reason, eligible patients receive consolidation therapy with early allogenic transplantation, but the recurrence rate remains high, even after transplantation. Moreover, the optimal therapy for patients with FLT3-ITD AML who relapse after allogeneic hematopoietic stem cell transplantation remains unclear. Here, we report a case in which graft-versus-leukemia (GVL) effects were induced by gilteritinib administration after a second transplant from the same donor, resulting in sustained remission of early FLT3-ITD AML relapse after allogeneic transplantation. Several studies suggest that the benefits of FLT3 tyrosine kinase inhibitors (FLT3-TKI) after allogeneic transplantation are attributable to GVL induction, as well as direct effects on FLT3 mutation-positive leukemia cells. With this in mind, we induced lymphodepletion using L-PAM to further enhance GVL induction by donor lymphocytes and FLT3-TKI. We believe that enhancement of GVL induction by lymphodepletion should be considered before FLT3-TKI use, if the prognosis is very poor, such as in patients with recurrence following allogeneic transplantation.

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Authors and Affiliations

  1. Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan

    Toshihiko Ando, Haruna Sano, Masako Yokoo, Kana Kusaba, Keisuke Kidoguchi, Kyosuke Yamaguchi, Hiroo Katsuya, Yasushi Kubota, Kensuke Kojima & Shinya Kimura

  2. Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan

    Satoshi Yoshihara

  3. Department of Transfusion Medicine, Saga University Hospital, Saga, Japan

    Yasushi Kubota

  4. Department of Hematology, Kochi Medical School, Kochi University, Kochi, Japan

    Kensuke Kojima

Authors
  1. Toshihiko Ando
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  2. Haruna Sano
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  3. Masako Yokoo
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  4. Kana Kusaba
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  5. Keisuke Kidoguchi
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  6. Kyosuke Yamaguchi
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  7. Hiroo Katsuya
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  8. Satoshi Yoshihara
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  9. Yasushi Kubota
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  10. Kensuke Kojima
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  11. Shinya Kimura
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Correspondence to Toshihiko Ando.

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Ando, T., Sano, H., Yokoo, M. et al. Durable remission of post-transplant relapsed FLT3-ITD AML in response to gilteritinib administration after a second transplant from the same donor. Int J Hematol 112, 249–253 (2020). https://doi.org/10.1007/s12185-020-02858-1

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  • DOI: https://doi.org/10.1007/s12185-020-02858-1

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