Investigating the effect of sorafenib drug after allogeneic transplantation in patients withFLT۳-ITD acute myeloid leukemia

Introduction: Acute myeloid leukemia (AML) is a clonal stem cell cancer. FMS-like tyrosine kinase ۳ (FLT۳)is a receptor tyrosine kinase, which is expressed in hematopoietic precursor cells, regulating stem cell growthand differentiation. Despite undergoing allogeneic hematopoietic stem cell transplantation (HCT), Patientsdiagnosed with AML with FLT۳ mutations have a very poor prognosis, frequently relapse, and die as a resultof AML. It is currently unknown whether a maintenance therapy using FLT۳ inhibitors, such as themultitargeted tyrosine kinase inhibitor sorafenib, improves outcome after HCT. The objective of this study wasto evaluate the effect of sorafenib on the outcomes of patients with AML with FLT۳ internal tandem duplication(ITD) undergoing HCT.Methods: Articles pertaining to the Effect of sorafenib after allogeneic hematopoietic stem cell transplantationfor acute myeloid leukemia with FLT۳-ITD mutation including ten original articles. Were retrieved through acomprehensive literature search by using several databases such as PubMed, Google Scholar, Scopus, Embase,and Cochrane until September ۲۰۲۳. Search key words such as sorafenib, transplantation, acute myeloidleukemia were used during the database search to target comparable articles.Results: This systematic study accrued ۱۰ articles until September ۲۰۲۳.In these articles, patients receivedsorafenib before allogeneic HSCT. Transplant conditioning regimens and donor sources were determined instudies. Correlative studies evaluating FLT۳ inhibition via a plasma inhibitory activity assay showed consistentinhibition of FLT۳ at all tolerability determined dosing levels. Sorafenib is well tolerated in the peritransplantsetting irrespective of the conditioning intensity or the donor source. In one study, patients with minimalundetectable residual disease (MRD) before HCT and those with detectable MRD after HCT were shown toderive the strongest benefit from sorafenib.Conclusion: Sorafenib before transplantation, sorafenib maintenance after transplantation, and their combinedapplication all could improve the outcomes for patients with FLT۳ ITD AML. sorafenib maintenance aftertransplantation is safe and associated with improved long term survival and reduced relapse rates compared withnon-maintenance, further supporting this strategy as a standard of care for patients with FLT۳ ITD acute myeloidleukaemia undergoing allogeneic HSCT. Further study is needed to determine whether the use of sorafenib bothbefore and after transplantation might be ideal.