Intensive Chemotherapy in Combination With Quizartinib Versus Midostaurin for FLT3-ITD Mutated Acute Myeloid Leukemia: A Multicenter Cohort Study

In this Pharmacy Times Rapid Readout, Jeffrey Baron, PharmD, BCOP, DPLA, a clinical pharmacy specialist in the Leukemia Division at Roswell Park Comprehensive Cancer Center in Buffalo, New York, reviews findings from a multicenter retrospective cohort study comparing quizartinib and midostaurin, each given with 7+3 intensive induction chemotherapy, in patients with newly diagnosed FLT3-ITD–mutated acute myeloid leukemia (AML). After framing the question with the pivotal RATIFY and QuANTUM-First trials, Baron notes that no prospective or large-scale studies have compared the 2 FLT3 inhibitors directly. The analysis included 215 adults (127 midostaurin, 88 quizartinib) treated between May 2017 and May 2025 across 12 US centers, most of whom had de novo, ELN intermediate-risk disease.

Quizartinib was associated with significantly higher 1-year overall survival (93% vs 78%), an advantage that held across age groups, by transplant status, and after adjustment for covariates (HR, 0.19; 95% CI, 0.07-0.52). One-year event-free survival was 77% vs 56%. Patients receiving midostaurin had more treatment interruptions or delays (25.2% vs 11.4%) and higher rates of ICU admission and discharge to rehabilitation facilities, supporting once-daily quizartinib as a preferred option for FLT3-ITD–positive disease.