A Modified-Delphi Consensus on the Management of Patients with FLT3-Mutated AML.

Area of Science:

• Hematology
• Oncology
• Clinical Practice Guidelines

Background:

• The advent of FLT3 inhibitors (FLT3i) has significantly altered the treatment paradigm for FLT3-mutated Acute Myeloid Leukemia (AML).
• This necessitates the development of structured, evidence-based clinical guidance for managing this patient population.
• Leading Italian experts identified the need for consensus on FLT3-mutated AML management across the disease continuum.

Purpose of the Study:

• To establish evidence-based recommendations for the management of FLT3-mutated AML.
• To provide guidance covering diagnosis, upfront therapy, allogeneic stem cell transplantation (allo-HSCT), minimal residual disease (MRD) monitoring, and relapsed/refractory (R/R) strategies.
• To minimize practice variability and optimize patient outcomes in FLT3-mutated AML.

Main Methods:

• A modified Delphi consensus process involving leading Italian experts.
• Development of recommendations based on the entire disease spectrum of FLT3-mutated AML.
• Focus on achieving expert agreement on key therapeutic and diagnostic interventions.

Main Results:

• High consensus achieved on diagnostic testing (FLT3-ITD/TKD analysis via capillary electrophoresis or NGS).
• Recommendations for upfront FLT3i (midostaurin/quizartinib) with intensive chemotherapy for fit patients, and evaluation for allo-HSCT.
• Emphasis on MRD monitoring for relapse risk assessment and allo-HSCT optimization, with gilteritinib as standard R/R treatment.

Conclusions:

• FLT3 inhibitors have improved the prognosis of FLT3-mutated AML, increasing the relevance of curative therapies like allo-HSCT.
• The consensus provides a structured, evidence-based guide for managing FLT3-mutated AML.
• These recommendations aim to standardize care and improve outcomes for high-risk AML patients.