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1. Therapeutic Management of Patients with FLT3 + Acute Myeloid Leukemia: Case Reports and Focus on Gilteritinib Monotherapy

Author

Bocchia, M, Carella, A, Mule, A, Rizzo, L, Turrini, M, Abbenante, M, Cairoli, R, Calafiore, V, Defina, M, Gardellini, A, Luzi, G, Patti, C, Pinazzi, M, Riva, M, Rossi, G, Sammartano, V, Rigacci, L, Bocchia M, Carella AM, Mule A, Rizzo L, Turrini M, Abbenante MC, Cairoli R, Calafiore V, Defina M, Gardellini A, Luzi G, Patti C, Pinazzi MB, Riva M, Rossi G, Sammartano V, Rigacci L., Bocchia, M, Carella, A, Mule, A, Rizzo, L, Turrini, M, Abbenante, M, Cairoli, R, Calafiore, V, Defina, M, Gardellini, A, Luzi, G, Patti, C, Pinazzi, M, Riva, M, Rossi, G, Sammartano, V, Rigacci, L, Bocchia M, Carella AM, Mule A, Rizzo L, Turrini M, Abbenante MC, Cairoli R, Calafiore V, Defina M, Gardellini A, Luzi G, Patti C, Pinazzi MB, Riva M, Rossi G, Sammartano V, and Rigacci L.

Abstract

Acute myeloid leukemia is a malignant disorder of the bone marrow, characterized by differentiation, clonal expansion, and uncontrolled proliferation of malignant myeloid progenitor cells and by several molecular and genetic abnormalities. A mutation of FMS-like tyrosine kinase 3 gene can be observed in about one-third of cases of acute myeloid leukemia. Two FLT3 inhibitors are actually approved for FLT3 mutated acute myeloid leukemia: midostaurin, a multikinase first generation inhibitor with lower affinity for FLT3 binding, and gilteritinib fumarate, a potent second-generation inhibitor of both FLT3-ITD and TKD. Gilteritinib is a new effective and well-tolerated drug for patients with relapsing or refractory FLT3-positive acute myeloid leukemia. Thanks to its efficacy, low toxicity, its good manageability (oral formulation), this drug is suitable for all the patients, including elderly frail patient with concomitant therapies or pre-existing or underlying diseases, and can be used also in the outpatient setting, reducing risks and costs related to the hospitalization. We report and discuss seven cases of different patients with FLT3 positive acute myeloid leukemia successfully managed with gilteritinib in the real clinical practice.

Published
2022

8. Therapeutic Management of Patients with FLT3 + Acute Myeloid Leukemia: Case Reports and Focus on Gilteritinib Monotherapy

Author

Bocchia,Monica, Carella,Angelo Michele, Mulè,Antonino, Rizzo,Lorenzo, Turrini,Mauro, Abbenante,Maria Chiara, Cairoli,Roberto, Calafiore,Valeria, Defina,Marzia, Gardellini,Angelo, Luzi,Giovanni, Patti,Caterina, Pinazzi,Maria Beatrice, Riva,Marta, Rossi,Giovanni, Sammartano,Vincenzo, Rigacci,Luigi, Bocchia, M, Carella, A, Mule, A, Rizzo, L, Turrini, M, Abbenante, M, Cairoli, R, Calafiore, V, Defina, M, Gardellini, A, Luzi, G, Patti, C, Pinazzi, M, Riva, M, Rossi, G, Sammartano, V, and Rigacci, L

Subjects
Pharmacology, midostaurin, Pharmacogenomics and Personalized Medicine, hemic and lymphatic diseases, Molecular Medicine, acute myeloid leukemia, FLT3, gilteritinib
Abstract

Monica Bocchia,1 Angelo Michele Carella,2 Antonino Mulè,3 Lorenzo Rizzo,4 Mauro Turrini,5 Maria Chiara Abbenante,2 Roberto Cairoli,4 Valeria Calafiore,3 Marzia Defina,1 Angelo Gardellini,5 Giovanni Luzi,6 Caterina Patti,3 Maria Beatrice Pinazzi,6 Marta Riva,4 Giovanni Rossi,2 Vincenzo Sammartano,1 Luigi Rigacci6 1Hematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy; 2Division of Hematology with Hematologic Intensive Care Unit and Cellular Therapies, Department of Medical Science, Fondazione IRCCS Casa Sollievo Della Sofferenza, Foggia, Italy; 3UOC Hematology and Oncology, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy; 4Department of Haematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; 5Division of Hematology, Valduce Hospital, Como, Italy; 6UOC Hematology and Stem Cell Transplant Unit, Ospedale S, Camillo, Rome, ItalyCorrespondence: Angelo Michele Carella, Division of Hematology with Hematologic Intensive Care Unit and Cellular Therapies, Department of Medical Science, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo, Foggia, 71013, Italy, Tel +390882410054, Fax +390882410322, Email am.carella@operapadrepio.itAbstract: Acute myeloid leukemia is a malignant disorder of the bone marrow, characterized by differentiation, clonal expansion, and uncontrolled proliferation of malignant myeloid progenitor cells and by several molecular and genetic abnormalities. A mutation of FMS-like tyrosine kinase 3 gene can be observed in about one-third of cases of acute myeloid leukemia. Two FLT3 inhibitors are actually approved for FLT3 mutated acute myeloid leukemia: midostaurin, a multikinase first generation inhibitor with lower affinity for FLT3 binding, and gilteritinib fumarate, a potent second-generation inhibitor of both FLT3-ITD and TKD. Gilteritinib is a new effective and well-tolerated drug for patients with relapsing or refractory FLT3-positive acute myeloid leukemia. Thanks to its efficacy, low toxicity, its good manageability (oral formulation), this drug is suitable for all the patients, including elderly frail patient with concomitant therapies or pre-existing or underlying diseases, and can be used also in the outpatient setting, reducing risks and costs related to the hospitalization. We report and discuss seven cases of different patients with FLT3 positive acute myeloid leukemia successfully managed with gilteritinib in the real clinical practice.Keywords: acute myeloid leukemia, FLT3, midostaurin, gilteritinib

Published
2022
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9. Alterations of the FLT3 gene in acute promyelocytic leukemia: association with diagnostic characteristics and analysis of clinical outcome in patients treated with the Italian AIDA protocol.

Author

Noguera NI, Breccia M, Divona M, Diverio D, Costa V, De Santis S, Avvisati G, Pinazzi MB, Petti MC, Mandelli F, and Lo Coco F

Subjects
Acute Disease, Adult, Aged, DNA Primers chemistry, DNA, Neoplasm metabolism, Female, Hemoglobins analysis, Humans, Leukemia, Promyelocytic, Acute diagnosis, Leukemia, Promyelocytic, Acute drug therapy, Leukocyte Count, Male, Middle Aged, Mutation, Neoplasm Proteins genetics, Neoplasm Proteins metabolism, Oncogene Proteins, Fusion genetics, Oncogene Proteins, Fusion metabolism, Platelet Count, RNA, Messenger metabolism, RNA, Neoplasm metabolism, Reverse Transcriptase Polymerase Chain Reaction, Risk Factors, Tandem Repeat Sequences, Treatment Outcome, fms-Like Tyrosine Kinase 3, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Idarubicin therapeutic use, Leukemia, Promyelocytic, Acute genetics, Proto-Oncogene Proteins genetics, Receptor Protein-Tyrosine Kinases genetics, Tretinoin therapeutic use
Abstract

Alterations in the FLT3 gene, including internal tandem duplications (ITDs) and D835 mutations occur frequently in acute myelogenous leukemia. We investigated the prevalence and clinico-biological correlations of FLT3 ITDs and D835 mutations in 90 patients with acute promyelocytic leukemia (APL) receiving the AIDA protocol. Twenty patients in which both presentation and relapse material was available were analyzed sequentially. Thirty-three patients (37%) harbored the ITD, and seven (7.7%) the D835 mutation in blasts obtained at diagnosis. Presence of ITDs was strongly associated with high WBC count (P = 0.0001), M3 variant (P = 0.0004), and the short (BCR3) PML/RARalpha isoform (P = 0.003). There was no difference in response to induction in the two ITD+ve and ITD-ve groups, while a trend towards inferior outcome was observed for ITD+ve cases when analyzing disease-free survival (DFS) and relapse risk (RR). These differences, however, did not reach statistical significance. Sequential studies showed variable patterns in diagnostic and relapse material, ie ITD (-ve/-ve, +ve/+ve, +ve/-ve, -ve/+ve) and D835 (-ve/-ve, +ve/-ve, -ve/+ve). Our results indicate that FLT3 alterations are associated in APL with more aggressive clinical features and suggest that these lesions may not play a major role in leukemia progression.

Published
2002
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10. Prolonged molecular remission in advanced acute promyelocytic leukaemia after treatment with gemtuzumab ozogamicin (Mylotarg CMA-676).

Author

Petti MC, Pinazzi MB, Diverio D, Romano A, Petrucci MT, De Santis S, Meloni G, Tafuri A, Mandelli F, and Lo Coco F

Subjects
Adult, Antibiotics, Antineoplastic therapeutic use, Antibodies, Monoclonal, Humanized, Antigens, CD immunology, Antigens, Differentiation, Myelomonocytic immunology, Arsenic Trioxide, Arsenicals therapeutic use, Central Nervous System immunology, Combined Modality Therapy, Female, Gemtuzumab, Gene Rearrangement, Genes, MDR, Hematopoietic Stem Cell Transplantation, Humans, Leukemia, Promyelocytic, Acute immunology, Leukemic Infiltration, Oxides therapeutic use, Sialic Acid Binding Ig-like Lectin 3, Translocation, Genetic, Tretinoin therapeutic use, Aminoglycosides, Anti-Bacterial Agents therapeutic use, Antibodies, Monoclonal therapeutic use, Leukemia, Promyelocytic, Acute drug therapy, Leukemia, Promyelocytic, Acute genetics
Abstract

We report a patient with acute promyelocytic leukaemia (APL) who received two doses of gemtuzumab ozogamicin for advanced disease. Previous treatments included front-line all-trans retinoic acid and anthracyclines, polychemotherapy consolidation, salvage chemotherapy for the first relapse followed by autologous stem cell transplantation (ASCT), arsenic trioxide for the second relapse followed by a second ASCT and then high-dose methotrexate for more advanced systemic disease with central nervous system involvement. The patient achieved prolonged haematological and molecular remission after monotherapy with gemtuzumab ozogamicin given at the time of the third relapse.

Published
2001
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