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Myelomonocytic differentiation of leukemic blasts accompanied by differentiation syndrome in a case of FLT3-ITD-positive AML treated with gilteritinib

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Title: Myelomonocytic differentiation of leukemic blasts accompanied by differentiation syndrome in a case of FLT3-ITD-positive AML treated with gilteritinib
Authors: Kondo, Takeshi Browse this author
Onozawa, Masahiro Browse this author
Fujisawa, Shinichi Browse this author
Harada, Shinpei Browse this author
Ogasawara, Reiki Browse this author
Izumiyama, Koh Browse this author
Saito, Makoto Browse this author
Morioka, Masanobu Browse this author
Mori, Akio Browse this author
Teshima, Takanori Browse this author →KAKEN DB
Keywords: Acute myelogenous leukemia
normal karyotype
Fms-like tyrosine kinase 3
internal tandem duplication
variant allele frequency
differentiation syndrome
FLT3 inhibitor
gilteritinib
Issue Date: 1-Jan-2021
Publisher: Taylor & Francis
Journal Title: Hematology
Volume: 26
Issue: 1
Start Page: 256
End Page: 260
Publisher DOI: 10.1080/16078454.2021.1889111
PMID: 33631087
Abstract: Fms-like tyrosine kinase 3 (FLT3) is one of the most frequently mutated genes in acute myelogenous leukemia (AML) and the mutation is associated with poor prognosis of patients. Two distinct types of activating mutations have been identified in AML samples. One is internal tandem duplications in the juxtamembrane domain (FLT3-ITD) and the other is point mutations in the tyrosine kinase domain (FLT3-TKD). Gilteritinib is a FLT3 inhibitor that inhibits both FLT3-ITD and FLT3-TKD. It was reported that differentiation of leukemic blasts accompanied by differentiation syndrome occurs in some patients treated with gilteritinib. However, information about the precise clinical course is limited, and appropriate management of differentiation syndrome has not been established. We report a case of relapsed AML with FLT3-ITD that was treated with gilteritinib. Analysis of the FLT3-ITD variant allele frequency (VAF) revealed that FLT3-ITD VAF was not decreased despite achievement of complete remission with incomplete hematologic recovery. Remarkable increases of monocytes and granulocytes accompanied by differentiation syndrome were observed at 6 months after the initiation of gilteritinib treatment. Intermittent chemotherapy with low-dose cytarabine and mitoxantrone was effective for reducing myelomonocytosis and resolving differentiation syndrome.
Type: article
URI: http://hdl.handle.net/2115/81078
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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