FLT3-ITD mutation

P1, N=9, Not yet recruiting, Fred Hutchinson Cancer Center

P1, N=38, Recruiting, National Cancer Institute (NCI) | N=28 --> 38

After six cycles of azacitidine, she achieved remission of MDS but rapidly progressed to AML and ultimately died. This case provides a key clinical lesson: persistent cytopenias during ibrutinib therapy were attributable to MDS progression rather than SWM, underscoring the importance of re-evaluation. Furthermore, it completely documents clonal evolution from 2.5% blasts (MDS with low blasts) to 6% blasts (MDS with increased blasts-1) and ultimately to AML (66% blasts), and it introduces the emergence of an FLT3-ITD mutation that rapidly drove the disease into AML even after the patient had achieved MDS remission. We also review the rare coexistence of WM and MDS/AML, and MGUS with MDS.

In this large multicenter cohort, KIT and FLT3-ITD mutations did not adversely affect the prognosis of pediatric CBF-AML treated according to the C-HUANAN-AML-15 protocol. MRD after induction was the most powerful predictor of relapse and survival, underscoring its importance for risk stratification in future pediatric AML trials.

P1/2, N=20, Active, not recruiting, M.D. Anderson Cancer Center | Recruiting --> Active, not recruiting

And post-HCT FLT3 inhibitor maintenance independently improved RFS (p = 0.003), with greatest benefit observed in MRD-positive patients. These findings support PCR-NGS-based molecular MRD assessment to refine risk stratification and guide individualized transplant strategies in FLT3-ITD-mutated AML.

Moreover, Compound 14 demonstrated an impressive pharmacokinetic profile and exerted significant antitumor efficacy in the FLT3-ITD-positive AML xenograft mouse model (approximately 80% decrease in tumor mass). Also, biochemical blood analysis and histopathological studies revealed that Compound 14 demonstrated a good safety profile.

P1/2, N=58, Recruiting, Hellenic Society Of Hematology | Not yet recruiting --> Recruiting

Here, we define a clinically actionable strategy that functionally targets PLK1 by combining inhibition of the AAA+ ATPase p97/valosin-containing protein (VCP) with the hypomethylating agent decitabine (DAC). In vivo, CB-5339/DAC is well tolerated, significantly prolongs survival, reduces leukemic burden, and suppresses PLK1 in bone marrow blasts. Together, these data establish p97 inhibition as a rational means to exploit replication and proteotoxic stress in AML and provide strong rationale for clinical evaluation of CB-5339 plus DAC in high-risk disease.

We describe a 60-year-old man with FLT3-ITD-mutated acute myeloid leukemia (AML) who achieved durable remission following venetoclax-based therapy and a combined HLA-matched sibling HCT-kidney transplant with FLT3 inhibitor maintenance. Four years post-transplant, he developed chronic myelomonocytic leukemia (CMML-1) characterized by re-emergence of driver mutations without FLT3-ITD, marked loss of donor myeloid chimerism, preserved donor T-cell chimerism, and sustained renal allograft function. This case highlights a unique clinical circumstance that may function to recontextualize myelomonocytic features in AML: that they can be attributed to acute leukemias arising from clonal hematopoiesis or occult chronic malignancies, as opposed to de novo AML, particularly given the difficulty in differentiating the two in the acute leukemic setting.

Its mutation subtype, molecular context, treatment setting, assay performance and standardized reporting determine its diagnostic, prognostic, predictive and MRD-related value. This review offers a clinical laboratory perspective on how to interpret FLT3 mutations as actionable biomarkers in AML.

CRc rates were higher with venetoclax-based intensive (88.2%) or non-intensive (63.6%) CMT than with CMT alone (p = 0.001). In conclusion, this study offers a potential treatment paradigm for AML patients with co-occurring FLT3-ITD, NPM1 and DNMT3A mutations.