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Synergistic effect of sorafenib and cGvHD in patients with high-risk FLT3-ITD+AML allows long-term disease control after allogeneic transplantation

Tschan-Plessl, A. ; Halter, J. ; Heim, D. ; Medinger, M. ; Passweg, J. ; Gerull, S.

In: Annals of Hematology, 2015, vol. 94, no. 11, p. 1899-1905

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    Title
    • Synergistic effect of sorafenib and cGvHD in patients with high-risk FLT3-ITD+AML allows long-term disease control after allogeneic transplantation
    Author
    • Tschan-Plessl, A.. Department of Hematology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
    • Halter, J.. Department of Hematology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
    • Heim, D.. Department of Hematology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
    • Medinger, M.. Department of Hematology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
    • Passweg, J.. Department of Hematology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
    • Gerull, S.. Department of Hematology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:331189
    Summary
    The multikinase inhibitor sorafenib has shown a strong anti-leukemic effect in FMS-like tyrosine kinase 3 (FLT3)-mutated acute myeloid leukemia (AML); however, remission is often transient. To better understand the role of sorafenib, we performed a retrospective analysis of all patients who received sorafenib in combination with allogeneic hematopoietic stem cell transplantation (HSCT) at our center. Seventeen patients with FLT3-ITD positive AML were treated with sorafenib in combination with allogeneic HSCT. Seven patients received sorafenib therapy pre- and posttransplant, and 10 patients were given sorafenib only posttransplant. Median duration of sorafenib treatment was 13months (range 1-42); median dose was 600mg (range 100-1200). Fourteen patients (82%) achieved a complete remission (CR), while 5 patients (29%) eventually developed progressive disease. Developing chronic graft-versus-host disease (GvHD) had a strong protective influence on the risk of sorafenib resistance (p = 0.028, HR 0.08, 95% CI 0.01-0.76). In a total of 8 patients, sorafenib had to be stopped, paused or dose-reduced due to toxicity. In 5 patients with pronounced toxicity, we switched to an alternating dosing schedule with 1month on/1month off sorafenib. These patients subsequently remained in sustained complete molecular remission, with a median follow-up of 20months. Our data indicate that sorafenib can achieve high rates of sustained remission in high-risk patients treated in combination with HSCT.