Does FLT3-ITD allelic ratio affect midostaurin benefit?

RATIFY trial showed midostaurin benefit across all FLT3-ITD allelic ratios. However, high allelic ratio (above 0.5) confers worse prognosis. AlloSCT in first remission is recommended for high allelic ratio FLT3-ITD patients per ELN 2022 adverse risk classification.

What is the significance of FLT3-TKD vs ITD mutations?

FLT3-TKD (D835 tyrosine kinase domain) mutations are not classified as adverse risk unlike ITD mutations. They respond to quizartinib but are less sensitive to midostaurin. TKD mutations without ITD do not require alloSCT in first remission.

FLT3-ITD Allelic Ratio and Prognosis in AML

Interpret FLT3-ITD allelic ratio: high allelic ratio (above 0.5) without NPM1 mutation confers adverse risk in AML; lower ratios with co-occurring NPM1 mutation shift to intermediate or favorable risk.

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FLT3-ITD Allelic Ratio and Prognosis in AML

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Frequently Asked Questions

Does FLT3-ITD allelic ratio affect midostaurin benefit?

What is the significance of FLT3-TKD vs ITD mutations?