Management and risk mitigation strategies for FLT3-ITD+ acute myeloid leukemia: clinical utilization of quizartinib.

Acute myeloid leukemia (AML) with FMS-like tyrosine kinase 3 (FLT3) mutations represent a clinically aggressive subtype of AML characterized by a poor prognosis and high frequency of relapse. Although several FLT3 inhibitors exist, they differ in their side effects, potency and clinical use. Quizartinib is a potent next generation FLT3 inhibitor with a risk of QTc-prolongation necessitating a Risk Evaluation and Mitigation Strategies (REMS) program as well as potential drug-drug interactions with strong CYP3A4 inhibitors. Here we detail two patient cases illustrating the real-world use of quizartinib in combination with anthracycline and cytarabine-based chemotherapy and maintenance monotherapy for the management of FLT3-ITD+ AML. These cases highlight the practical recommendations on management of quizartinib-based chemotherapy in accordance with the Food and Drug Administration (FDA)-mandated REMS requirements. Adopting these strategies to optimize the safe treatment of FLT3-ITD+ AML with quizartinib may ultimately improve patient outcomes in this highly challenging malignancy.