Effective treatment with Gilteritinib-based regimens for FLT3-mutant extramedullary relapse in acute promyelocytic leukemia

Figures & data

Figure 1. Clinical time courses and treatment of the three patients.

Figure 2. (A) PET-CT images of the head and whole body of the patient 1. Red arrows indicate the EMR in the left external auditory meatusa. (B) PET-CT after decitabine plus ATRA and ATO combination chemotherapy with local radiotherapy, which resulted in disappearance of the EMR in the left external auditory meatusa. (C) PET-CT after 1 month of Gilteritinib therapy showing complete disappearance of the EMR in the left lumber.

Table 1. Clinical characteristics and therapeutic regimens of the three patients.

NO.	Age at relapse/sex	Leukemia status	Upfront treatment	Time from CR to first relapse	Localization of EMR	BM Status	Mutations	Gilteritinib-based regimens
1	30/M	The third EMD after UCBT	1.ATRA, ATO and DNR for induction and consolidation; 2. UCBT after second hematologic relapse; 3 ATRA, ATO, chemotherapy with local radiotherapy for first EMR;	4.8y	skin	mCR	BM: negative EMD: FLT3-ITD (AR = 0.85); CALR; ARIDIB; ARID2; BIRC3; EGFR	Gilteritinib (120 mg, d1∼d28) +Ven (100 mg d1, 200 mg d2, 400 mg d3∼28) + AZA (75 mg/m^2, d1∼d7) for the first month; Gilteritinib (120 mg, d1∼d28) + ATRA (25 mg/m^2/d, d1∼d14) and RIF (60 mg/kg/d, d15∼d28) for the second month, then followed by a 14days rest. 2.5 months therapy unit a cycle.
2	43/M	The second EMR	1.ATRA and ATO for induction and consolidation; 2. ATRA and ATO for first hematologic relapse and EMR	12y	CNS	mCR	BM: negative EMD: WT1, FLT3(D835Y)	ATO (0.16 mg/kg/d for 2 weeks every 4 months) or RIF (60 mg/kg/d for 2 weeks every 4 months) +ATRA (25 mg/m2/d for 4 weeks on 4 weeks off) + Gilteritinib (120 mg/d for 3 months on month off).4 months therapy unit a cycle.
3	73/M	Molecular relapse and the first EMR	1. ATRA combined chemotherapy for induction and consolidation; 2. ATRA and ATO for maintenance	1.7y	CNS	CR^MRD+	BM: FLT3-ITD (AR = 0.85) EMD: FLT3-ITD (47.07%)	ATO (0.16 mg/kg/d for 4 weeks on 4 weeks off) +ATRA (25 mg/m^2/d for 2 weeks on 2 weeks off) +Gilteritinib (80 mg/d for 4 weeks on 4 weeks off)

Data availability statement

The data supporting this study's findings are available from the corresponding author upon reasonable request.