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 Blood, 25 June 2009, Vol. 113, No. 26, pp. 6567-6571.
Prepublished online as a Blood First Edition Paper on April 23, 2009; DOI 10.1182/blood-2009-03-208298.

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CLINICAL TRIALS AND OBSERVATIONS

Brief report

Compassionate use of sorafenib in FLT3-ITD–positive acute myeloid leukemia: sustained regression before and after allogeneic stem cell transplantation

Stephan Metzelder1, Ying Wang1, Ellen Wollmer1, Michael Wanzel2, Sabine Teichler1, Anuhar Chaturvedi1, Martin Eilers3, Erich Enghofer4, Andreas Neubauer1, and Andreas Burchert1

1 Philipps University of Marburg, Medical Center of the University Giessen and Marburg, Campus Marburg, Department of Hematology, Oncology and Immunology, Marburg; 2 Institute for Molecular Biology and Tumor Research, Marburg; 3 Department of Physiological Chemistry, Biocenter, Universität Würzburg, Würzburg; and 4 Bayer Schering Pharma, BU Oncology, Leverkusen, Germany

Acute myeloid leukemia (AML) patients with internal tandem duplication (ITD) mutations in the Fms-like tyrosine-3 (FLT3) gene have a dismal prognosis. Here we report compassionate-use results with the multikinase and FLT3-ITD inhibitor sorafenib for the treatment of relapsed or refractory FLT3-ITD–positive AML. Sorafenib induced clinically meaningful and very rapid responses in all 6 patients treated either before (n = 2), after (n = 3), or both before and after (n = 1) allogeneic stem cell transplantation (allo-SCT). Sorafenib-induced remissions facilitated allo-SCT in 2 of the 3 refractory patients. Two of the 4 patients who were treated after allo-SCT survived 216 and 221 days, respectively, whereas the other 2 remain in ongoing complete molecular remission. Sorafenib response was associated with an inhibition of the antiapoptotic FLT3-ITD target Stat-5 in vivo. Together, sorafenib monotherapy before or after allo-SCT has remarkable clinical activity in poor risk FLT3-ITD–positive AML and deserves further evaluation in prospective clinical trials.


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