51. Sorafenib maintenance in patients with FLT3-ITD acute myeloid leukaemia undergoing allogeneic haematopoietic stem-cell transplantation: an open-label, multicentre, randomised phase 3 trial
- Author
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Xinquan Liang, Pengcheng Shi, Zhiping Fan, Xuan Zhou, Lan Deng, Xudong Li, Xiao-Jun Huang, Xiaodan Luo, Fen Huang, Li Xuan, Na Xu, Ling Jiang, Chunzi Yu, Zhixiang Wang, Hui Liu, Sanfang Tu, Yu Wang, Yan Chen, Ren Lin, Qifa Liu, Yajing Xu, and Jing Sun
- Subjects
Sorafenib ,Adult ,Male ,medicine.medical_specialty ,China ,Myeloid ,Adolescent ,Drug-Related Side Effects and Adverse Reactions ,Population ,Graft vs Host Disease ,Disease-Free Survival ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Internal medicine ,Clinical endpoint ,medicine ,Humans ,Transplantation, Homologous ,Cumulative incidence ,education ,Protein Kinase Inhibitors ,education.field_of_study ,business.industry ,Hazard ratio ,Remission Induction ,Hematopoietic Stem Cell Transplantation ,Middle Aged ,Transplantation ,Leukemia, Myeloid, Acute ,medicine.anatomical_structure ,Oncology ,Tolerability ,fms-Like Tyrosine Kinase 3 ,Tandem Repeat Sequences ,030220 oncology & carcinogenesis ,Female ,business ,030215 immunology ,medicine.drug - Abstract
Summary Background Findings of retrospective studies suggest that sorafenib maintenance post-transplantation might reduce relapse in patients with FLT3 internal tandem duplication (FLT3-ITD) acute myeloid leukaemia undergoing allogeneic haematopoietic stem-cell transplantation. We investigated the efficacy and tolerability of sorafenib maintenance post-transplantation in this population. Methods We did an open-label, randomised phase 3 trial at seven hospitals in China. Eligible patients (aged 18–60 years) had FLT3-ITD acute myeloid leukaemia, were undergoing allogeneic haematopoietic stem-cell transplantation, had an Eastern Cooperative Oncology Group performance status of 0–2, had composite complete remission before and after transplantation, and had haematopoietic recovery within 60 days post-transplantation. Patients were randomly assigned (1:1) to sorafenib maintenance (400 mg orally twice daily) or non-maintenance (control) at 30–60 days post-transplantation. Randomisation was done with permuted blocks (block size four) and implemented through an interactive web-based randomisation system. The primary endpoint was the 1-year cumulative incidence of relapse in the intention-to-treat population. This trial is registered with ClinicalTrials.gov , NCT02474290 ; the trial is complete. Findings Between June 20, 2015, and July 21, 2018, 202 patients were enrolled and randomly assigned to sorafenib maintenance (n=100) or control (n=102). Median follow-up post-transplantation was 21·3 months (IQR 15·0–37·0). The 1-year cumulative incidence of relapse was 7·0% (95% CI 3·1–13·1) in the sorafenib group and 24·5% (16·6–33·2) in the control group (hazard ratio 0·25, 95% CI 0·11–0·57; p=0·0010). Within 210 days post-transplantation, the most common grade 3 and 4 adverse events were infections (25 [25%] of 100 patients in the sorafenib group vs 24 [24%] of 102 in the control group), acute graft-versus-host-disease (GVHD; 23 [23%] of 100 vs 21 [21%] of 102), chronic GVHD (18 [18%] of 99 vs 17 [17%] of 99), and haematological toxicity (15 [15%] of 100 vs seven [7%] of 102). There were no treatment-related deaths. Interpretation Sorafenib maintenance post-transplantation can reduce relapse and is well tolerated in patients with FLT3-ITD acute myeloid leukaemia undergoing allogeneic haematopoietic stem-cell transplantation. This strategy could be a suitable therapeutic option for patients with FLT3-ITD acute myeloid leukaemia. Funding None.
- Published
- 2020