Allogeneic Hematopoietic Stem Cell Transplantation for Older Patients With Acute Myeloid Leukemia

  • Rebecca Levin-Epstein
  • Caspian Oliai
  • Gary Schiller
Leukemia (PH Wiernik, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Leukemia

Opinion statement

Acute myelogenous leukemia (AML) in the elderly is complex and has a poor prognosis, often characterized by higher risk cytogenetic and molecular features compared to that in younger patients. Rates of transplant have been limited by concern related to non-relapse mortality, as older patients have historically been considered medically unfit for the transplantation process. Reduced-intensity conditioning (RIC) for hematopoietic stem cell transplantation (HSCT) has been shown to provide similar efficacy to myeloablative methods, with decreased non-relapse mortality in the elderly and improved efficacy over non-transplant approaches with cytotoxic chemotherapy alone. Targeted non-cytotoxic and modified cytotoxic agents have emerged to further improve transplant outcomes for older AML patients. Validated comorbidity indices are useful tools to assess an individual’s fitness for undergoing HSCT rather than chronological age alone. We believe HSCT is the primary curative treatment approach for many older AML patients, taking into account risk and comorbidities, particularly given the tendency of leukemia in this population to harbor an unfavorable disease profile. We use RIC and advocate for the addition of targeted agents if applicable. With continuing data in support of transplant for older AML patients, we anticipate that transplant rates in this population will continue to rise.


AML Elderly AML Stem cell transplant Allogeneic transplant Reduced-intensity conditioning 


Compliance with Ethics Guidelines

Conflict of interest

Rebecca Levin-Epstein declares that she has no conflict of interest. Caspian Oliai declares that he has no conflict of interest. Gary Schiller reports the following outside the submitted work: grants from AbbVie; grants, personal fees, and speakers’ bureau involvement from Agios; grants from Actinium; grants from Ambit; grants, personal fees, and speakers’ bureau involvement from Amgen; grants from Ariad; grants from Array Biopharma; grants and personal fees from Astellas; grants and grant-reviewer activities from Leukemia and Lymphoma Society; grants from BioMed Valley Discoveries; grants from Boehringer Ingelheim; grants from Celator; grants and speakers’ bureau involvement from Celgene; grants from Forma; grants from Cyclacel; grants from Daiichi Sankyo; grants and speakers’ bureau involvement from Incyte; grants and speakers’ bureau involvement from Janssen; grants and consultant contract from Karyopharm; grants from Mateon; grants from National Marrow Donor Program; grants from National Institute of Health; grants from Novartis; grants from Onconova; grants from Pfizer; grants from Tolero; grants from Trovagene; grants from University of California, Davis; grants from Bluebird Bio; grants and speakers’ bureau involvement from Bristol-Myers Squibb; grants from Cellerant; grants from CTI Biopharma; grants from Gilead; grants from Donald Kohn; grants and speakers’ bureau involvement from Kite Pharma; grants from Medimmune; grants from Millennium; grants from Onyx; grants from PharmaMar; grants from Sangamo Therapeutics; grants from Stemline Therapeutics; grants from University of California; San Diego; grants from BiolineRx; grants from Gamida; consultant contract from Medallion; consultant contract from Medeor; consultant contract from Merck; grants and speakers’ bureau involvement from Pharmacyclics; speakers’ bureau involvement from Sanofi; advisory board membership from Seattle Genetics; consultant contract from Stanford University Health; consultant contract from Sunesis; grants and consultant contract from Takeda; speakers’ bureau involvement from Dava Oncology; speakers’ bureau involvement from Genzyme; and speakers’ bureau involvement from Jazz.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, publish recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Luger SM. Treating the elderly patient with acute myelogenous leukemia. Hematol Am Soc Hematol Educ Program. 2010:62–9.Google Scholar
  2. 2.
    Juliusson G, Antunovic P, Derolf A, Lehmann S, Mollgard L, Stockelberg D, et al. Age and acute myeloid leukemia: real world data on decision to treat and outcomes from the Swedish Acute Leukemia Registry. Blood. 2009;113(18):4179–87.CrossRefGoogle Scholar
  3. 3.
    Oran B, Weisdorf DJ. Survival for older patients with acute myeloid leukemia: a population-based study. Haematologica. 2012;97(12):1916–24.CrossRefGoogle Scholar
  4. 4.
    Alibhai SMH, Leach M, Minden MD, Brandwein J. Outcomes and quality of care in acute myeloid leukemia over 40 years. Cancer. 2009;115(13):2903–11.CrossRefGoogle Scholar
  5. 5.
    Lerch E, Espeli V, Zucca E, Leoncini L, Scali G, Mora O, et al. Prognosis of acute myeloid leukemia in the general population: data from southern Switzerland. Tumori. 2009;95(3):303–10.CrossRefGoogle Scholar
  6. 6.
    Medeiros BC, Othus M, Fang M, Roulston D, Appelbaum FR. Prognostic impact of monosomal karyotype in young adult and elderly acute myeloid leukemia: the Southwest Oncology Group (SWOG) experience. Blood. 2010;116(13):2224–8.CrossRefGoogle Scholar
  7. 7.
    Bacher U, Kern W, Schnittger S, Hiddemann W, Haferlach T, Schoch C. Population-based age-specific incidences of cytogenetic subgroups of acute myeloid leukemia. Haematologica. 2005;90(11):1502–10.PubMedGoogle Scholar
  8. 8.
    Leith CP, Kopecky KJ, Godwin J, McConnell T, Slovak ML, Chen IM, et al. Acute myeloid leukemia in the elderly: assessment of multidrug resistance (MDR1) and cytogenetics distinguishes biologic subgroups with remarkably distinct responses to standard chemotherapy. A Southwest Oncology Group Study. Blood. 1997;89(9):3323–9.PubMedGoogle Scholar
  9. 9.
    Döhner H, Estey EH, Amadori S, Appelbaum FR, Büchner T, Burnett AK, et al. Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood. 2010;115(3):453–74.CrossRefGoogle Scholar
  10. 10.
    Lekakis L, de Lima M. Reduced-intensity conditioning and allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia. Expert Rev Anticancer Ther. 2008;8(5):785–98.CrossRefGoogle Scholar
  11. 11.
    Bacigalupo A, Ballen K, Rizzo D, Giralt S, Lazarus H, Ho V, et al. Defining the intensity of conditioning regimens: working definitions. Biol Blood Marrow Transplant. 2009;15(12):1628–33.CrossRefGoogle Scholar
  12. 12.
    Corradini P, Zallio F, Mariotti J, Farina L, Bregni M, Valagussa P, et al. Effect of age and previous autologous transplantation on nonrelapse mortality and survival in patients treated with reduced-intensity conditioning and allografting for advanced hematologic malignancies. J Clin Oncol. 2005;23(27):6690–8.CrossRefGoogle Scholar
  13. 13.
    Sorror ML. Comorbidities and hematopoietic cell transplantation outcomes. Hematol Am Soc Hematol Educ Program. 2010;1:237–47.CrossRefGoogle Scholar
  14. 14.
    McClune BL, Weisdorf DJ, Pedersen TL, et al. Effect of age on outcome of reduced-intensity hematopoietic cell transplantation for older patients with acute myeloid leukemia in first complete remission or with myelodysplastic syndrome. J Clin Oncol. 2010;28(11):1878–87.CrossRefGoogle Scholar
  15. 15.
    Champlin R, Khouri I, Kornblau S, Molldrem J, Giralt S. Reinventing bone marrow transplantation: reducing toxicity using nonmyeloablative, preparative regimens and induction of graft-versus-malignancy. Curr Opin Oncol. 1999;11(2):87–95.CrossRefGoogle Scholar
  16. 16.
    Abdul wahid SF, Ismail NA, Mohd-idris MR, et al. Comparison of reduced-intensity and myeloablative conditioning regimens for allogeneic hematopoietic stem cell transplantation in patients with acute myeloid leukemia and acute lymphoblastic leukemia: a meta-analysis. Stem Cells Dev. 2014;23(21):2535–52.CrossRefGoogle Scholar
  17. 17.
    National Comprehensive Cancer Network. Acute myeloid leukemia (Version 1.2016).
  18. 18.
    Sengsayadeth S, Savani BN, Blaise D, Malard F, Nagler A, Mohty M. Reduced intensity conditioning allogeneic hematopoietic cell transplantation for adult acute myeloid leukemia in complete remission - a review from the Acute Leukemia Working Party of the EBMT. Haematologica. 2015;100(7):859–69.CrossRefGoogle Scholar
  19. 19.
    Alyea EP, Kim HT, Ho V, Cutler C, Gribben J, DeAngelo D, et al. Comparative outcome of nonmyeloablative and myeloablative allogeneic hematopoietic cell transplantation for patients older than 50 years of age. Blood. 2005;105(4):1810–4.CrossRefGoogle Scholar
  20. 20.
    Scott BL, Sandmaier BM, Storer B, et al. Myeloablative vs nonmyeloablative allogeneic transplantation for patients with myelodysplastic syndrome or acute myelogenous leukemia with multilineage dysplasia: a retrospective analysis. Leukemia. 2005;20(1):128–35.CrossRefGoogle Scholar
  21. 21.
    Bornhäuser M, Kienast J, Trenschel R, Burchert A, Hegenbart U, Stadler M, et al. Reduced-intensity conditioning versus standard conditioning before allogeneic haemopoietic cell transplantation in patients with acute myeloid leukaemia in first complete remission: a prospective, open-label randomised phase 3 trial. Lancet Oncol. 2012;13(10):1035–44.CrossRefGoogle Scholar
  22. 22.
    •• Devine SM, Owzar K, Blum W, et al. Phase II study of allogeneic transplantation for older patients with acute myeloid leukemia in first complete remission using a reduced-intensity conditioning regimen: results from Cancer and Leukemia Group B 100103 (Alliance for Clinical Trials in Oncology)/Blood and Marrow Transplant Clinical Trial Network 0502. J Clin Oncol. 2015;33(35):4167–75 This was the first major prospective phase II trial specifically for the older AML population. The trial showed that reduced-intensity conditioning in this population has relatively low non-relapse mortality, good leukemia-free survival, and overall survival, and superior outcomes compared to data reported for non-transplant methods.CrossRefGoogle Scholar
  23. 23.
    Whitman SP, Maharry K, Radmacher MD, Becker H, Mrozek K, Margeson D, et al. FLT3 internal tandem duplication associates with adverse outcome and gene- and microRNA-expression signatures in patients 60 years of age or older with primary cytogenetically normal acute myeloid leukemia: a Cancer and Leukemia Group B study. Blood. 2010;116(18):3622–6.CrossRefGoogle Scholar
  24. 24.
    Mohty M, de Lavallade H, El-Cheikh J, et al. Reduced intensity conditioning allogeneic stem cell transplantation for patients with acute myeloid leukemia: long term results of a “donor” vs. “no donor” comparison. Leukemia. 2008;23(1):194–6.CrossRefGoogle Scholar
  25. 25.
    Russell NH, Kjeldsen L, Craddock C, et al. A comparative assessment of the curative potential of reduced intensity allografts in acute myeloid leukaemia. Leukemia. 2015;29(7):1478–84.CrossRefGoogle Scholar
  26. 26.
    Kurosawa S, Yamaguchi T, Uchida N, Miyawaki S, Usuki K, Watanabe M, et al. Comparison of allogeneic hematopoietic cell transplantation and chemotherapy in elderly patients with non-M3 acute myelogenous leukemia in first complete remission. Biol Blood Marrow Transplant. 2011;17(3):401–11.CrossRefGoogle Scholar
  27. 27.
    Kim DS, Kang K-W, Lee SR, Park Y, Sung HJ, Kim SJ, et al. Comparison of consolidation strategies in acute myeloid leukemia: high-dose cytarabine alone versus intermediate-dose cytarabine combined with anthracyclines. Ann Hematol. 2015;94(9):1485–92.CrossRefGoogle Scholar
  28. 28.
    Farag SS, Maharry K, Zhang MJ, Pérez WS, George SL, Mrózek K, et al. Comparison of reduced-intensity hematopoietic cell transplantation with chemotherapy in patients aged 60–70 years with acute myeloid leukemia in first remission. Biol Blood Marrow Transplant. 2011;17(12):1796–803.CrossRefGoogle Scholar
  29. 29.
    Baer MR, George SL, Caligiuri MA, Sanford BL, Bothun SM, Mrózek K, et al. Low-dose interleukin-2 immunotherapy does not improve outcome of patients age 60 years and older with acute myeloid leukemia in first complete remission: Cancer and Leukemia Group B Study 9720. J Clin Oncol. 2008;26(30):4934–9.CrossRefGoogle Scholar
  30. 30.
    Marcucci G, Maharry K, Whitman SP, Vukosavljevic T, Paschka P, Langer C, et al. High expression levels of the ETS-related gene, ERG, predict adverse outcome and improve molecular risk-based classification of cytogenetically normal acute myeloid leukemia: a Cancer and Leukemia Group B Study. J Clin Oncol. 2007;25(22):3337–43.CrossRefGoogle Scholar
  31. 31.
    • Lancet JE, Uy GL, Cortes JE, et al. CPX-351 (cytarabine and daunorubicin) liposome for injection versus conventional cytarabine plus daunorubicin in older patients with newly diagnosed secondary acute myeloid leukemia. J Clin Oncol. 2018;36(26):2684–92 This trial demonstrated improved rates of CR/CRi, OS, HSCT, and post-transplant survival in high risk/secondary elderly AML using liposomal CPX-351 compared to standard 7+3 induction.CrossRefGoogle Scholar
  32. 32.
    Lancet JE, Hoering A, Uy GL, et al. Survival following allogeneic hematopoietic cell transplantation in older high-risk acute myeloid leukemia patients initially treated with CPX-351 liposome injection versus standard cytarabine and daunorubicin: subgroup analysis of a large phase III trial. Blood. 2016;128:906.Google Scholar
  33. 33.
    Grosso DA, Hess RC, Weiss MA. Immunotherapy in acute myeloid leukemia. Cancer. 2015;121(16):2689–704.CrossRefGoogle Scholar
  34. 34.
    Lauter A, Strumpf A, Platzbecker U, Schetelig J, Wermke M, Radke J, et al. 188Re anti-CD66 radioimmunotherapy combined with reduced-intensity conditioning and in-vivo T cell depletion in elderly patients undergoing allogeneic haematopoietic cell transplantation. Br J Haematol. 2010;148(6):910–7.CrossRefGoogle Scholar
  35. 35.
    Schneider S, Strumpf A, Schetelig J, Wunderlich G, Ehninger G, Kotzerke J, et al. Reduced-intensity conditioning combined with (188)Rhenium radioimmunotherapy before allogeneic hematopoietic stem cell transplantation in elderly patients with acute myeloid leukemia: the role of in vivo T cell depletion. Biol Blood Marrow Transplant. 2015;21(10):1754–60.CrossRefGoogle Scholar
  36. 36.
    • Oran B, Jimenez AM, De Lima M, et al. Age and modified European LeukemiaNet classification to predict transplant outcomes: an integrated approach for acute myelogenous leukemia patients undergoing allogeneic stem cell transplantation. Biol Blood Marrow Transplant. 2015;21(8):1405–12 This study demonstrated the importance of transplant for patients with FLT3-mutated AML, with older patients achieving similar outcomes to younger patients with the mutation.CrossRefGoogle Scholar
  37. 37.
    Stone RM, Mandrekar SJ, Sanford BL, Laumann K, Geyer S, Bloomfield CD, et al. Midostaurin plus chemotherapy for acute myeloid leukemia with a FLT3 mutation. N Engl J Med. 2017;377(5):454–64.CrossRefGoogle Scholar
  38. 38.
    Gratwohl A, Stern M, Brand R, Apperley J, Baldomero H, de Witte T, et al. Risk score for outcome after allogeneic hematopoietic stem cell transplantation. Cancer. 2009;115(20):4715–26.CrossRefGoogle Scholar
  39. 39.
    Sorror ML, Estey E. Allogeneic hematopoietic cell transplantation for acute myeloid leukemia in older adults. ASH Education Program Book. 2014;2014(1):21–33.Google Scholar
  40. 40.
    Watson M, Buck G, Wheatley K, Homewood JR, Goldstone AH, Rees JK, et al. Adverse impact of bone marrow transplantation on quality of life in acute myeloid leukaemia patients. Eur J Cancer. 2004;40(7):971–8.CrossRefGoogle Scholar
  41. 41.
    Herr AL, Labopin M, Blaise D, Milpied N, Potter M, Michallet M, et al. HLA-identical sibling allogeneic peripheral blood stem cell transplantation with reduced intensity conditioning compared to autologous peripheral blood stem cell transplantation for elderly patients with de novo acute myeloid leukemia. Leukemia. 2006;21(1):129–35.CrossRefGoogle Scholar
  42. 42.
    Schetelig J, Bornhäuser M, Schmid C, Hertenstein B, Schwerdtfeger R, Martin H, et al. Matched unrelated or matched sibling donors result in comparable survival after allogeneic stem-cell transplantation in elderly patients with acute myeloid leukemia: a report from the cooperative german transplant study group. J Clin Oncol. 2008;26(32):5183–91.CrossRefGoogle Scholar
  43. 43.
    Lee CJ, Savani BN, Mohty M, Labopin M, Ruggeri A, Schmid C, et al. Haploidentical hematopoietic cell transplantation for adult acute myeloid leukemia: a position statement from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Haematologica. 2017;102(11):1810–22.CrossRefGoogle Scholar
  44. 44.
    Di Stasi A, Milton DR, Poon LM, et al. Similar transplant outcomes for acute myeloid leukemia and myelodysplastic syndrome patients with haploidentical versus 10/10 HLA matched unrelated and related donors. Biol Blood Marrow Transplant. 2014;20(12):1975–81.CrossRefGoogle Scholar
  45. 45.
    Blaise D, Fürst S, Crocchiolo R, el-Cheikh J, Granata A, Harbi S, et al. Haploidentical T cell–replete transplantation with post-transplantation cyclophosphamide for patients in or above the sixth decade of age compared with allogeneic hematopoietic stem cell transplantation from an human leukocyte antigen–matched related or unrelated donor. Biol Blood Marrow Transplant. 2016;22(1):119–24.CrossRefGoogle Scholar
  46. 46.
    Slade M, DiPersio JF, Westervelt P, Vij R, Schroeder MA, Romee R. Haploidentical hematopoietic cell transplant with post-transplant cyclophosphamide and peripheral blood stem cell grafts in older adults with acute myeloid leukemia or myelodysplastic syndrome. Biol Blood Marrow Transplant. 2017;23(10):1736–43.CrossRefGoogle Scholar
  47. 47.
    Ringdén O, Labopin M, Beelen DW, Volin L, Ehninger G, Finke J, et al. Bone marrow or peripheral blood stem cell transplantation from unrelated donors in adult patients with acute myeloid leukaemia, an Acute Leukaemia Working Party analysis in 2262 patients. J Intern Med. 2012;272(5):472–83.CrossRefGoogle Scholar
  48. 48.
    Anasetti C, Logan BR, Lee SJ, Waller EK, Weisdorf DJ, Wingard JR, et al. Peripheral-blood stem cells versus bone marrow from unrelated donors. N Engl J Med. 2012;367(16):1487–96.CrossRefGoogle Scholar
  49. 49.
    Holtick U, Albrecht M, Chemnitz JM, et al. Bone marrow versus peripheral blood allogeneic haematopoietic stem cell transplantation for haematological malignancies in adults. Cochrane Database of Syst Rev. 2014;4:CD010189.Google Scholar
  50. 50.
    Maschan M, Shelikhova L, Ilushina M, Kurnikova E, Boyakova E, Balashov D, et al. TCR-alpha/beta and CD19 depletion and treosulfan-based conditioning regimen in unrelated and haploidentical transplantation in children with acute myeloid leukemia. Bone Marrow Transplant. 2016;51:668–74.CrossRefGoogle Scholar
  51. 51.
    Bethge W, Mielke S, Niederwieser D, et al. First results of a prospective multicenter phase I/II clinical trial in adult patients using TCR alpha/beta and CD19 depleted haploidentical stem cell transplantation following reduced intensity conditioning. Blood. 2017;130(Suppl 1):213–3.Google Scholar
  52. 52.
    Triplett BM, Shook DR, Eldridge P, Li Y, Kang G, Dallas M, et al. Rapid memory t-cell reconstitution recapitulating CD45RA-depleted haploidentical transplant graft content in patients with hematologic malignancies. Bone Marrow Transplant. 2015;50(7):968–77.CrossRefGoogle Scholar
  53. 53.
    Buccisano F, Maurillo L, Piciocchi A, del Principe MI, Sarlo C, Cefalo M, et al. Minimal residual disease negativity in elderly patients with acute myeloid leukemia may indicate different postremission strategies than in younger patients. Ann Hematol. 2015;94(8):1319–26.CrossRefGoogle Scholar
  54. 54.
    Walter RB, Gyurkocza B, Storer BE, Godwin CD, Pagel JM, Buckley SA, et al. Comparison of minimal residual disease as outcome predictor for AML patients in first complete remission undergoing myeloablative or nonmyeloablative allogeneic hematopoietic cell transplantation. Leukemia. 2015;29(1):137–44.CrossRefGoogle Scholar
  55. 55.
    Faderl S, Wetzler M, Rizzieri D, Schiller G, Jagasia M, Stuart R, et al. Clofarabine plus cytarabine compared with cytarabine alone in older patients with relapsed or refractory acute myelogenous leukemia: results from the CLASSIC I trial. J Clin Oncol. 2012;30(20):2492–9.CrossRefGoogle Scholar
  56. 56.
    Kharfan-Dabaja MA, Labopin M, Polge E, et al. Adoptive cellular therapy with donor lymphocyte infusion versus a second allogeneic hematopoietic cell transplant for post-allograft relapsed acute myeloid leukemia: an intent-to-treat analysis on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT). Blood. 2017;130(Suppl 1):273–3.Google Scholar
  57. 57.
    Radich JP, Sanders JE, Buckner CD, Martin PJ, Petersen FB, Bensinger W, et al. Second allogeneic marrow transplantation for patients with recurrent leukemia after initial transplant with total-body irradiation-containing regimens. J Clin Oncol. 1993;11(2):304–13.CrossRefGoogle Scholar
  58. 58.
    Gale RP, Wiernik PH, Lazarus HM. Should persons with acute myeloid leukemia have a transplant in first remission? Leukemia. 2014;28(10):1949–52.CrossRefGoogle Scholar
  59. 59.
    DiNardo C, De Botton S, Stein E, et al. Ivosidenib (AG-120) in mutant IDH1 AML and advanced hematologic malignancies: results of a phase 1 dose escalation and expansion study. Presented at the 2017 ASH annual meeting, abstract 725; December 11, 2017; Atlanta, GA.Google Scholar
  60. 60.
    • Stein EM, Dinardo CD, Pollyea DA, et al. Enasidenib in mutant IDH2 relapsed or refractory acute myeloid leukemia. Blood. 2017;130(6):722–31 This study demonstrates efficacy of a targeted non-cytotoxic agent for relapsed/refractory AML in heavily pretreated elderly patients. Given the higher risk of relapse in this population, targeted non-cytotoxic agents play an important role in achieving prolonged stable disease or even CR, and in a small subset, bridge to repeat transplant.CrossRefGoogle Scholar
  61. 61.
    Stein E, Stone R, Pollyea D, et al. Continuing enasidenib treatment for patients with mutatnt IDH2 relapsed or refractory acute myeloid leukemia with stable disease may result in improved survival and responses over time. Presented at the 2017 ASH annual meeting, abstract 1299; December 9, 2017; Atlanta, GA.Google Scholar
  62. 62.
    Levis MJ, Perl AE, Dombret H, et al. Final results of a phase 2 open-label, monotherapy efficacy and safety study of Quizartinib (AC220) in patients with FLT3-ITD positive or negative relapsed/refractory acute myeloid leukemia after second-line chemotherapy or hematopoietic stem cell transplantation. Blood. 2012;120(21):673.Google Scholar
  63. 63.
    Smith CC, Paguirigan A, Jeschke GR, Lin KC, Massi E, Tarver T, et al. Heterogeneous resistance to quizartinib in acute myeloid leukemia (AML) revealed by single cell analysis. Blood. 2017;130:48–58.CrossRefGoogle Scholar
  64. 64.
    Perl AE, Altman JK, Cortes J, Smith C, Litzow M, Baer MR, et al. Selective inhibition of FLT3 by gilteritinib in relapsed or refractory acute myeloid leukaemia: a multicentre, first-in-human, open-label, phase 1-2 study. Lancet Oncol. 2017;18(8):1061–75.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Rebecca Levin-Epstein
    • 1
  • Caspian Oliai
    • 2
  • Gary Schiller
    • 2
  1. 1.UCLA Department of Radiation OncologyLos AngelesUSA
  2. 2.UCLA Department of Hematology OncologyLos AngelesUSA

Personalised recommendations