Onkológia 5/2025
Case report of a patient with acute myeloid leukemia on maintenance therapy with gilteritinib after allogeneic transplantation
Introduction: Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy characterized by a wide range of genetic alterations. FLT3 gene (FMS-like tyrosine kinase 3) mutations are detected in approximately 25-30% of cases.
Objective: To present a novel therapeutic approach for patients with relapsed or refractory AML harboring the FLT3/ITD mutation.
Case description: A 58-year-old patient with AML, unspecified, who initially showed massive bone marrow infiltration (cytometrically 89%, histologically 80% myeloblasts) and was FLT3/ITD- and WT1-positive, with intermediate risk (ELN2022). After initial treatment, the patient achieved complete remission with minimal residual disease (MRD), FLT3/ITD and WT1 negativity. However, while being prepared for a related allogeneic stem cell transplantation (SCT), the patient experienced an early relapse with FLT3/ITD and WT1 positivity. In response, salvage chemotherapy was initiated but did not result in significant improvement. As an alternative, gilteritinib monotherapy was started, leading to MRD and making the planned allogeneic SCT possible. Following transplantation, maintenance treatment with gilteritinib was continued, resulting in sustained complete remission and continued FLT3/ITD and WT1 negativity.
Conclusion: Gilteritinib is a selective, oral, second-generation FLT3 inhibitor effective against ITD and TKD mutations. In this case, it proved to be an effective, well-tolerated therapeutic option for patients with FLT3-mutated AML. Gilteritinib is approved as monotherapy for adults with relapsed or refractory FLT3-mutated AML.
Keywords: AML, FLT3/ITD mutation, transplantation, gilteritinib
