Treatment of older adults with newly diagnosed FLT3-mutated AML: focus on lower-intensity triplet regimens.

IF 2.8 4区医学 Q2 HEMATOLOGY

Expert Review of Hematology Pub Date : 2026-08-18 DOI:10.1080/17474086.2026.2720126

Sankalp Arora, Naval Daver, Farhad Ravandi, Nicholas J Short

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引用次数: 0

Abstract

Introduction: Treatment options for older adults with FLT3-mutated AML who are unfit for intensive chemotherapy have evolved substantially. The combination of hypomethylating agent (HMA) and venetoclax is the current standard-of-care regimen for these patients, though outcomes remain suboptimal, particularly in FLT3-ITD mutated AML. More recently, encouraging data have emerged supporting the safety and efficacy of frontline HMA + venetoclax + FLT3 inhibitor 'triplet' regimens.

Areas covered: We summarize the available evidence for different frontline treatment approaches in older adults with FLT3-mutated AML. We also discuss key practical considerations for the use of triplet regimens and provide recommendations to optimize drug doses and durations and improve tolerability. Relevant literature search was carried out using PubMed/MEDLINE databases through June 2026.

Expert opinion: The HMA + venetoclax + FLT3 inhibitor triplet regimens, when administered with appropriate dose optimization and supportive care, can be delivered safely, with very high response rates and improved long-term survival in older adults with FLT3-mutated AML, positioning them as a potential new standard-of-care option. However, randomized controlled trial data are still awaited, and their safe administration requires close monitoring, robust supportive care and expertise that is most readily available at specialized academic centers.

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老年人新诊断的flt3突变AML的治疗：专注于低强度的三联方案

不适合强化化疗的flt3突变AML老年人的治疗选择已经发生了实质性的变化。低甲基化剂（HMA）和venetoclax的联合治疗是目前这些患者的标准治疗方案，尽管结果仍然不理想，特别是在FLT3-ITD突变的AML中。最近，令人鼓舞的数据支持一线HMA + venetoclax + FLT3抑制剂“三联”方案的安全性和有效性。涵盖的领域：我们总结了flt3突变的老年AML患者不同一线治疗方法的现有证据。我们还讨论了使用三联疗法的关键实际考虑因素，并提供了优化药物剂量和持续时间以及提高耐受性的建议。使用PubMed/MEDLINE数据库进行相关文献检索，检索截止至2026年6月。专家意见：HMA + venetoclax + FLT3抑制剂三重方案，在适当的剂量优化和支持性护理下，可以安全交付，对FLT3突变的老年AML患者具有非常高的反应率和改善的长期生存率，将其定位为潜在的新标准治疗选择。然而，随机对照试验数据仍在等待中，它们的安全管理需要密切监测，强有力的支持性护理和专业学术中心最容易获得的专业知识。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Hematology HEMATOLOGY-

CiteScore

4.70

自引率

3.60%

发文量

审稿时长

6-12 weeks

期刊介绍： Advanced molecular research techniques have transformed hematology in recent years. With improved understanding of hematologic diseases, we now have the opportunity to research and evaluate new biological therapies, new drugs and drug combinations, new treatment schedules and novel approaches including stem cell transplantation. We can also expect proteomics, molecular genetics and biomarker research to facilitate new diagnostic approaches and the identification of appropriate therapies. Further advances in our knowledge regarding the formation and function of blood cells and blood-forming tissues should ensue, and it will be a major challenge for hematologists to adopt these new paradigms and develop integrated strategies to define the best possible patient care. Expert Review of Hematology (1747-4086) puts these advances in context and explores how they will translate directly into clinical practice.