Sorafenib treatment following hematopoietic stem cell transplant in pediatric FLT3/ITD acute myeloid leukemia

Katherine Tarlock, Bill Chang, Todd Cooper, Thomas Gross, Sumit Gupta, Steven Neudorf, Kathleen Adlard, Phoenix A. Ho, Suzanne Mcgoldrick, Tanya Watt, Tina Templeman, India Sisler, Amy Garee, Blythe Thomson, Ann Woolfrey, Elihu Estey, Soheil Meshinchi, Jessica A. Pollard

Research output: Contribution to journalArticle

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Abstract

Background: FLT3/ITD is associated with poor outcomes in adult and pediatric acute myeloid leukemia (AML). Allogeneic hematopoietic stem cell transplantation (HSCT) can improve cure rates, however relapse is still common. Recent studies demonstrate the activity of FLT3 inhibitors, including sorafenib, in targeting the underlying mutation. Procedure: We conducted a retrospective study of 15 pediatric patients with FLT3/ITD+ AML treated with sorafenib within 18 months after receiving HSCT. Sorafenib was administered either as prophylaxis in patients considered at very high risk for relapse (n=6) or at the time of disease recurrence (n=9). Results: Sorafenib was initiated at a median of 100 days post HSCT. Overall, 11/15 (73%) of patients experienced medically significant toxicities. Among patients who experienced toxicity, 6/11 (55%) received treatment at doses above what was later determined to be the maximum tolerated dose of sorafenib for pediatric leukemia. Importantly, sorafenib did not appear to exacerbate graft versus host disease. Our findings suggest that sorafenib may be of particular efficacy in patients with minimal residual disease (MRD); all patients who received sorafenib for MRD immediately prior to transplant or with emergence post-HSCT are alive and remain in complete remission at a median of 48 months post HSCT. Conclusions: Our case series suggests that sorafenib administration is feasible and tolerable in pediatric FLT3/ITD+ AML patients early post HSCT. Ongoing prospective controlled studies are needed to further define the dosing of sorafenib in the post-HSCT period and to determine the optimal context for this treatment approach.

Original languageEnglish (US)
Pages (from-to)1048-1054
Number of pages7
JournalPediatric Blood and Cancer
Volume62
Issue number6
DOIs
StatePublished - Jun 1 2015

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Hematopoietic Stem Cells
Acute Myeloid Leukemia
Hematopoietic Stem Cell Transplantation
Pediatrics
Transplants
Therapeutics
Residual Neoplasm
Recurrence
sorafenib
Maximum Tolerated Dose
Graft vs Host Disease
Leukemia
Retrospective Studies
Prospective Studies
Mutation

Keywords

  • Acute myeloid leukemia
  • FLT3/ITD
  • Pediatric
  • Sorafenib
  • Transplant

ASJC Scopus subject areas

  • Oncology
  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Medicine(all)

Cite this

Sorafenib treatment following hematopoietic stem cell transplant in pediatric FLT3/ITD acute myeloid leukemia. / Tarlock, Katherine; Chang, Bill; Cooper, Todd; Gross, Thomas; Gupta, Sumit; Neudorf, Steven; Adlard, Kathleen; Ho, Phoenix A.; Mcgoldrick, Suzanne; Watt, Tanya; Templeman, Tina; Sisler, India; Garee, Amy; Thomson, Blythe; Woolfrey, Ann; Estey, Elihu; Meshinchi, Soheil; Pollard, Jessica A.

In: Pediatric Blood and Cancer, Vol. 62, No. 6, 01.06.2015, p. 1048-1054.

Research output: Contribution to journalArticle

Tarlock, K, Chang, B, Cooper, T, Gross, T, Gupta, S, Neudorf, S, Adlard, K, Ho, PA, Mcgoldrick, S, Watt, T, Templeman, T, Sisler, I, Garee, A, Thomson, B, Woolfrey, A, Estey, E, Meshinchi, S & Pollard, JA 2015, 'Sorafenib treatment following hematopoietic stem cell transplant in pediatric FLT3/ITD acute myeloid leukemia', Pediatric Blood and Cancer, vol. 62, no. 6, pp. 1048-1054. https://doi.org/10.1002/pbc.25437
Tarlock, Katherine ; Chang, Bill ; Cooper, Todd ; Gross, Thomas ; Gupta, Sumit ; Neudorf, Steven ; Adlard, Kathleen ; Ho, Phoenix A. ; Mcgoldrick, Suzanne ; Watt, Tanya ; Templeman, Tina ; Sisler, India ; Garee, Amy ; Thomson, Blythe ; Woolfrey, Ann ; Estey, Elihu ; Meshinchi, Soheil ; Pollard, Jessica A. / Sorafenib treatment following hematopoietic stem cell transplant in pediatric FLT3/ITD acute myeloid leukemia. In: Pediatric Blood and Cancer. 2015 ; Vol. 62, No. 6. pp. 1048-1054.
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abstract = "Background: FLT3/ITD is associated with poor outcomes in adult and pediatric acute myeloid leukemia (AML). Allogeneic hematopoietic stem cell transplantation (HSCT) can improve cure rates, however relapse is still common. Recent studies demonstrate the activity of FLT3 inhibitors, including sorafenib, in targeting the underlying mutation. Procedure: We conducted a retrospective study of 15 pediatric patients with FLT3/ITD+ AML treated with sorafenib within 18 months after receiving HSCT. Sorafenib was administered either as prophylaxis in patients considered at very high risk for relapse (n=6) or at the time of disease recurrence (n=9). Results: Sorafenib was initiated at a median of 100 days post HSCT. Overall, 11/15 (73{\%}) of patients experienced medically significant toxicities. Among patients who experienced toxicity, 6/11 (55{\%}) received treatment at doses above what was later determined to be the maximum tolerated dose of sorafenib for pediatric leukemia. Importantly, sorafenib did not appear to exacerbate graft versus host disease. Our findings suggest that sorafenib may be of particular efficacy in patients with minimal residual disease (MRD); all patients who received sorafenib for MRD immediately prior to transplant or with emergence post-HSCT are alive and remain in complete remission at a median of 48 months post HSCT. Conclusions: Our case series suggests that sorafenib administration is feasible and tolerable in pediatric FLT3/ITD+ AML patients early post HSCT. Ongoing prospective controlled studies are needed to further define the dosing of sorafenib in the post-HSCT period and to determine the optimal context for this treatment approach.",
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AU - Tarlock, Katherine

AU - Chang, Bill

AU - Cooper, Todd

AU - Gross, Thomas

AU - Gupta, Sumit

AU - Neudorf, Steven

AU - Adlard, Kathleen

AU - Ho, Phoenix A.

AU - Mcgoldrick, Suzanne

AU - Watt, Tanya

AU - Templeman, Tina

AU - Sisler, India

AU - Garee, Amy

AU - Thomson, Blythe

AU - Woolfrey, Ann

AU - Estey, Elihu

AU - Meshinchi, Soheil

AU - Pollard, Jessica A.

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Background: FLT3/ITD is associated with poor outcomes in adult and pediatric acute myeloid leukemia (AML). Allogeneic hematopoietic stem cell transplantation (HSCT) can improve cure rates, however relapse is still common. Recent studies demonstrate the activity of FLT3 inhibitors, including sorafenib, in targeting the underlying mutation. Procedure: We conducted a retrospective study of 15 pediatric patients with FLT3/ITD+ AML treated with sorafenib within 18 months after receiving HSCT. Sorafenib was administered either as prophylaxis in patients considered at very high risk for relapse (n=6) or at the time of disease recurrence (n=9). Results: Sorafenib was initiated at a median of 100 days post HSCT. Overall, 11/15 (73%) of patients experienced medically significant toxicities. Among patients who experienced toxicity, 6/11 (55%) received treatment at doses above what was later determined to be the maximum tolerated dose of sorafenib for pediatric leukemia. Importantly, sorafenib did not appear to exacerbate graft versus host disease. Our findings suggest that sorafenib may be of particular efficacy in patients with minimal residual disease (MRD); all patients who received sorafenib for MRD immediately prior to transplant or with emergence post-HSCT are alive and remain in complete remission at a median of 48 months post HSCT. Conclusions: Our case series suggests that sorafenib administration is feasible and tolerable in pediatric FLT3/ITD+ AML patients early post HSCT. Ongoing prospective controlled studies are needed to further define the dosing of sorafenib in the post-HSCT period and to determine the optimal context for this treatment approach.

AB - Background: FLT3/ITD is associated with poor outcomes in adult and pediatric acute myeloid leukemia (AML). Allogeneic hematopoietic stem cell transplantation (HSCT) can improve cure rates, however relapse is still common. Recent studies demonstrate the activity of FLT3 inhibitors, including sorafenib, in targeting the underlying mutation. Procedure: We conducted a retrospective study of 15 pediatric patients with FLT3/ITD+ AML treated with sorafenib within 18 months after receiving HSCT. Sorafenib was administered either as prophylaxis in patients considered at very high risk for relapse (n=6) or at the time of disease recurrence (n=9). Results: Sorafenib was initiated at a median of 100 days post HSCT. Overall, 11/15 (73%) of patients experienced medically significant toxicities. Among patients who experienced toxicity, 6/11 (55%) received treatment at doses above what was later determined to be the maximum tolerated dose of sorafenib for pediatric leukemia. Importantly, sorafenib did not appear to exacerbate graft versus host disease. Our findings suggest that sorafenib may be of particular efficacy in patients with minimal residual disease (MRD); all patients who received sorafenib for MRD immediately prior to transplant or with emergence post-HSCT are alive and remain in complete remission at a median of 48 months post HSCT. Conclusions: Our case series suggests that sorafenib administration is feasible and tolerable in pediatric FLT3/ITD+ AML patients early post HSCT. Ongoing prospective controlled studies are needed to further define the dosing of sorafenib in the post-HSCT period and to determine the optimal context for this treatment approach.

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KW - FLT3/ITD

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KW - Sorafenib

KW - Transplant

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