Maintenance after allogeneic HSCT in acute myeloid leukaemia
Mené sur 202 patients atteints d’une leucémie myéloïde aiguë FLT3-ITD ayant reçu une greffe allogène de cellules souches hématopoïétiques, cet essai de phase III évalue l’efficacité, du point de vue de l’incidence cumulée à 1 an et de la récidive, et la toxicité du sorafénib en traitement d’entretien
Disease relapse is considered the main cause of treatment failure in patients undergoing allogeneic haematopoietic stem-cell transplantation (HSCT). 1 In The Lancet Oncology, Li Xuan and colleagues 2 show that use of sorafenib maintenance after allogeneic HSCT can reduce the risk of relapse and is well tolerated in patients with FLT3 internal tandem duplication ( FLT3-ITD) acute myeloid leukaemia. In the phase 3 trial, patients were randomly allocated to sorafenib maintenance or non-maintenance. A benefit of sorafenib maintenance was recorded with respect to the primary endpoint of 1-year cumulative incidence of relapse (hazard ratio [HR] 0·25, 95% CI 0·11–0·57; p=0·0010). The most common grade 3 or worse adverse events were infections, graft-versus-host disease (GVHD), and haematological toxicity. These findings suggest that sorafenib maintenance could be a treatment option for patients with FLT3-ITD acute myeloid leukaemia undergoing allogeneic HSCT, because it can substantially improve outcomes without increasing toxicity.
The Lancet Oncology , commentaire, 2019