FLT3 MUTATED AND WILDTYPE ACUTE MYELOID LEUKEMIA TREATMENT PATTERNS AND OUTCOMES AT A COMPREHENSIVE CANCER CENTER
Author(s)
Menon J1, Willis CW1, Unni S1, Au T1, Ndife B2, Joseph G2, Brixner D1, Stein EM3, Tantravahi S4, Shami P4, Kovacsovics T4, Stenehjem D5
1University of Utah, Salt Lake City, UT, USA, 2Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, 3Memorial Sloan Kettering Cancer Center, New York, UT, USA, 4Huntsman Cancer Institute, Salt Lake City, UT, USA, 5University of Utah and University of Minnesota, Salt Lake City, UT, USA
OBJECTIVES : Evaluate historical treatment practices and patient outcomes in acute myeloid leukemia (AML) at a single institution between patients with FLT3-mutated and FLT3-wildtype AML METHODS : This retrospective, observational study identified FLT3-tested AML patients treated with 7+3 induction chemotherapy from 2007-2016 at Huntsman Cancer Institute. Complete response (CR), relapse rates, and overall survival (OS) were compared in FLT3-mutated and FLT3-wildtype. RESULTS : One hundred patients (39 FLT3-mutated) were identified with a median age of 53 years. The CR rate to induction chemotherapy was 90% and 77% in FLT3-mutated and FLT3-wildtype, p=0.22. FLT3-mutated patients received fewer consolidation cycles than FLT3-wildtype (median 2 vs 3, p=0.0009) and were more likely to undergo transplant after consolidation (59% vs 25%, p=0.0079). Median time to transplant was 125 vs 186 days in FLT3-mutated and FLT3-wildtype, p=0.0028. After response to induction, 49% and 59% of FLT3-mutated and FLT3-wildtype patients relapsed, p=0.032. Salvage chemotherapy was administered to 38% (n=15) and 56% (n=34) of FLT3-mutated and FLT3-wildtype patients (p=0.092), and significantly fewer FLT3-mutated patients achieved a CR to salvage chemotherapy (40% [n=6] vs 74% [n=24], p=0.045). Median time to salvage chemotherapy was 218 vs 343 days in FLT3-mutated and FLT3-wildtype (p=0.056). A trend for shorter OS was observed in FLT3-mutated (HR 1.56; 95% CI 0.73-3.27; p=0.24). After censoring for transplant, OS was significantly shorter in FLT3-mutated (HR 4.81; 95% CI 1.61-14.39, p=0.006). CONCLUSIONS : Similar OS, CR and relapse rates were observed, although FLT3- mutated patients underwent transplant earlier and more frequently than FLT3-wildtype. In those without transplant, FLT3 survival was shorter than wildtype. Upon relapse, FLT3- mutated patients were less likely to respond to salvage treatment. This data resource will be expanded to similar institutions in the future to assess the impact of treatments recently approved for patients with FLT3-mutated AML.
Conference/Value in Health Info
2018-05, ISPOR 2018, Baltimore, MD, USA
Value in Health, Vol. 21, S1 (May 2018)
Code
PSY29
Topic
Epidemiology & Public Health
Disease
Systemic Disorders/Conditions