AML with FLT3-ITD or FLT3-TKD mutation — addition of midostaurin (or gilteritinib in r/r)...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-AML-FLT3-ACTIONABLE`
Type	Red flag
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	`DIS-AML`
Sources	`SRC-ELN-AML-2022` `SRC-NCCN-AML-2025` `SRC-RATIFY-STONE-2017`

Red Flag Origin

Definition	AML with FLT3-ITD or FLT3-TKD mutation — addition of midostaurin (or gilteritinib in r/r) to induction is required (RATIFY trial)
Clinical direction	intensify
Category	high-risk-biology
Shifts algorithm	ALGO-AML-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "flt3_itd",
      "value": true
    },
    {
      "finding": "flt3_tkd",
      "value": true
    },
    {
      "finding": "flt3_mutation",
      "value": "positive"
    }
  ],
  "type": "biomarker"
}

Notes

Triggers addition of midostaurin 50 mg PO BID days 8-21 to 7+3 induction + HiDAC consolidation in fit patients. Gilteritinib is the r/r-AML standard. NOT applicable for unfit patients on ven+aza (FLT3-targeting in that setting under investigation; not yet standard). Access: midostaurin not Ukraine-reimbursed — major barrier. STUB — requires clinical co-lead signoff.

Used By

Algorithms

ALGO-AML-1L - ALGO-AML-1L
ALGO-AML-2L - ALGO-AML-2L

Indications

IND-AML-1L-QUIZARTINIB-FLT3ITD - IND-AML-1L-QUIZARTINIB-FLT3ITD
IND-AML-2L-GILTERITINIB-FLT3 - IND-AML-2L-GILTERITINIB-FLT3

Red flag

RF-AML-CORE-BINDING-FACTOR-FAVORABLE - AML with core-binding-factor (CBF) cytogenetics: t(8;21)(q22;q22.1) with RUNX1::RUNX1T1 f...
RF-AML-MEASURABLE-RESIDUAL-DISEASE - AML with detectable measurable residual disease (MRD) after induction or consolidation —...
RF-AML-NPM1-MUT-FAVORABLE - NPM1 mutation (most commonly type-A: c.860_863dupTCTG / p.W288fs) in AML — ~30% of adult...