AML17 trial update: FLT3-ITD mutation and daunorubicin dosage

Nigel Russell, MD, from Nottingham University Hospitals NHS Trust, Nottingham, UK discusses the potential benefit of a higher dose of daunorubicin for a sub-group of acute myeloid leukemia (AML) patients with the FLT3-ITD mutation. This study was conducted as part of the AML17 trial and the abstract was presented at the 2016 World Congress of the International Society of Hematology (ISH) held in Glasgow, Scotland. Patients were randomized to receive two different doses of daunorubicin at induction therapy. Prof Russell discusses the initial report, which showed that there was no advantage to using the higher dose of daunorubicin. However, further follow-up has revealed that there is a sub-group of patients with the FLT3-ITD mutation who appear to benefit from the higher dose as indicated by overall survival (OS). Prof Russell further discusses next steps for the treatment of this sub-group of patients and in particular, the possibility of using FLT3 inhibitors in combination with a higher dose of daunorubicin as well as using new formulations of daunorubicin, which is currently investigated as part of the AML19 trial (ISRCTN78449203).