FLT3-ITD in newly-diagnosed AML: midostaurin + 7+3 induction + high-dose cytarabine conso...
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| ID | BMA-FLT3-ITD-AML |
|---|---|
| Tipo | Relevância terapêutica |
| Estado | reviewed 2026-04-27 | pending_clinical_signoff | actionability review required |
| Doenças | DIS-AML |
| Fontes | SRC-CIVIC SRC-ELN-AML-2022 SRC-ESMO-AML-2020 SRC-NCCN-AML-2025 SRC-QUANTUM-FIRST-ERBA-2023 SRC-RATIFY-STONE-2017 |
Fatos de ação
| Biomarcador | BIO-FLT3-ITD |
|---|---|
| Variante | internal tandem duplication (juxtamembrane domain — ~25% of AML) |
| Doença | DIS-AML |
| Nível ESCAT | IA |
| Combinações recomendadas | midostaurin + 7+3 induction + HiDAC consolidation + midostaurin maintenance, quizartinib + 7+3 induction + HiDAC consolidation + quizartinib maintenance (FLT3-ITD specifically), allo-SCT in CR1 (high-allelic-ratio FLT3-ITD or other adverse-risk features) |
| Contraindicated monotherapy | FLT3i em monoterapia (fora do ensaio; combinar com quimio ou utilização em R/R) |
| Resumo das provas | FLT3-ITD in newly-diagnosed AML: midostaurin + 7+3 induction + high-dose cytarabine consolidation + maintenance improved OS vs chemo alone in fit adults (RATIFY, Stone NEJM 2017 — 4-yr OS HR 0.78). Quizartinib + 7+3 + maintenance also superior in QuANTUM-First (Erba Lancet 2023 — 4-yr OS HR 0.78). FLT3-ITD remains a poor-risk marker (ELN 2022) when allelic ratio high; allo-SCT in CR1 indicated. |
Notas
ESCAT IA. OncoKB Level 1. ELN 2022: high-allelic-ratio FLT3-ITD without NPM1 = adverse risk; FLT3-ITD with NPM1 (any AR) = intermediate. Companion diagnostic: LeukoStrat CDx FLT3 mutation assay (RT-PCR-based).
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