FLT3 Inhibitors as Maintenance Therapy Post Hematopoietic Cell Transplantation for Acute Myeloid Leukemia (AML): A Systematic Review and Meta-Analysis

The purpose of this paper is to systematically analyze the outcome of FLT3 inhibitors maintenance treatment following hematopoietic stem cell transplantation (HSCT) for patients suffering from FLT3-ITD-mutated acute myeloid leukemia (AML). Pubmed, Embase, and Cochrane Library databases were retrieved before November 2021. Fifteen studies were included eventually containing six without control and nine with control. Thirteen studies evaluated sorafenib, and two assessed quizartinib and midostaurin, separately. Via survival analysis, the main outcomes in the FLT3 inhibitors group were improved greatly with the hazard ratio(HR) of overall survival of 0.38 (95% confidence interval [CI], 0.29-0.49; P < 0.001), HR of leukemia-free survival of 0.35 (95%CI, 0.27-0.47; P < 0.001) and HR of cumulative incidence of relapse of 0.32 (95%CI, 0.23-0.45; P < 0.001). Moreover, the TKI use didn’t seem to increase the incidence of graft-versus-host disease (GVHD) and adverse effects in statistics. Through subgroup analysis, MRD-positive patients before and after HCT, and MRD-negative patients before HCT might benefit a lot from sorafenib maintenance.