MRD‑guided maintenance after transplant: gilteritinib versus sorafenib

Post-transplant Optimization Based on Ultra-high Sensitivity MRD Detection: A Prospective, Randomized Controlled Study Comparing Gilteritinib Versus Sorafenib as Post-transplant Maintenance Therapy in FLT3-ITD Mutation-positive Acute Myeloid Leukemia Patients

This trial tests whether taking gilteritinib or sorafenib after an allogeneic stem cell transplant helps people aged 14–70 with FLT3‑ITD–positive AML who were MRD‑positive before transplant.

Quick facts

• Phase: Phase 3
• Study type: Interventional
• Enrollment: 594 (estimated)
• Ages: 14 Years to 70 Years
• Sex: All
• Sponsor: The First Affiliated Hospital of Soochow University (Academic / other)
• Drugs / interventions: Girotinib, prednisone, gilteritinib
• Locations: 2 sites (Suzhou, Jiangsu and 1 other locations)
• Trial ID: NCT07463651 on ClinicalTrials.gov

What this trial studies

This is an open‑label, randomized Phase 3 trial that assigned 594 patients 1:1 to receive maintenance therapy with either gilteritinib or sorafenib after allogeneic hematopoietic stem cell transplantation. All participants had FLT3‑ITD–mutated AML, were in morphological complete remission before transplant, and were MRD‑positive by central PCR‑NGS testing within 30 days prior to transplant. The trial treatment phase lasts up to two years, with efficacy and safety follow‑up until death, withdrawal, or two years after the first dose. The primary comparison is relapse and survival outcomes between the two maintenance arms.

Who should consider this trial

Good fit: Ideal candidates are people aged 14–70 with FLT3‑ITD–mutated AML who achieved morphological remission and were MRD‑positive by PCR‑NGS within 30 days before allogeneic HSCT and have ECOG performance status 0–2.

Not a fit: Patients unlikely to benefit include those who were MRD‑negative before transplant, lack the FLT3‑ITD mutation, are outside the age or performance limits, or cannot tolerate post‑transplant TKI therapy.

Why it matters

Potential benefit: If successful, this could identify the better maintenance drug to lower relapse risk and improve survival for MRD‑positive FLT3‑ITD AML patients after transplant.

How similar studies have performed: Previous trials have shown sorafenib can reduce post‑transplant relapse in FLT3‑ITD AML, while gilteritinib has proven activity in relapsed/refractory FLT3‑mutant disease but is less established as post‑transplant maintenance.

Eligibility criteria

Inclusion Criteria:

* Informed consent and willingness to participate in this clinical study;

  * Gender is not limited, age range is 14-70 years old (including threshold);

    * ECOG score 0-2 points;

      * Diagnosed with AML through bone marrow morphology, immunology, cytogenetics, and molecular biology (MICM) typing, and confirmed to have FLT3-ITD mutation;

        * Successfully accepted allo HSCT, with no restrictions on the pre-treatment protocol, allowing any donor source \[fully matched cell, unrelated donor (URD), incompatible unrelated donor, haploidentical relative donor or umbilical cord blood\], allowing any graft source \[umbilical cord blood, bone marrow (BM), peripheral blood (PB)\]; ⑥ Patients with complete morphological remission (CR) prior to allo HSCT, and FLT3-ITD MRD positivity detected by PCR-NGS within 30 days prior to allo HSCT (defined as FLT3-ITD transcript level ≥ 10 - 6);

          ⑦ After transplantation: hematopoietic function implantation (ANC ≥ 500/μ L, platelet count ≥ 20000/μ L and not dependent on infusion), oral administration of investigational drugs, exclusion of overlap syndrome, complete donor chimerism (FDC) status, no activity requiring daily prednisone dose\>0.5 mg/kg, acute GVHD;

          ⑧ Clinical laboratory tests meet the following criteria: a. Serum creatinine ≤ 2.0 times the upper limit of normal value; b. Total bilirubin ≤ 2.5 mg/dL (excluding Gilbert syndrome patients); c. Serum AST and/or ALT\<3 times the upper limit of normal values;

          ⑨ Maintenance treatment should be started 60 to 90 days after transplantation;

          ⑩ Female participants must meet the following criteria: have undergone menopause (at least 1 year without menstruation) or surgical sterilization (at least 1 month ago) before screening for infertility; Or have the ability to conceive but agree not to plan pregnancy during the study period and within 6 months after the last dose; Conduct pregnancy tests during the screening period; If there is heterosexual behavior, agree to continue using local standard high-efficiency contraceptive measures plus barrier method from the beginning of screening to 6 months after the last administration; Agree not to breastfeed or donate eggs during the study period and for 6 months after the last administration Male participants must meet the following requirements: male participants (even if sterilized) and their reproductive partners must use efficient contraception plus barrier method during the study period and within 127 days after the last dose; Male participants are not allowed to donate sperm during the study period and for 127 days after the last dose;

Exclusion Criteria:

* Allergies to Girotinib or Sorafenib, as well as any components of the therapeutic drugs used during the study period;

  * Any serious comorbidities that make patients unsuitable for participation in this study or may affect protocol compliance;

    * FLT3-ITD molecular MRD positivity before maintenance therapy;

      * Severe organ dysfunction such as organ failure occurs after allogeneic hematopoietic stem cell transplantation;

        * Subjects who are positive for hepatitis B B surface antigen (HBsAg) and whose hepatitis B virus (HBV) DNA titer is higher than the upper limit of the normal value range of the research center, and who are judged by the researchers not suitable for this study; Individuals with positive hepatitis C virus (HCV) antibodies and positive peripheral blood HCV RNA; Individuals who are HIV antibody positive; Positive syphilis test results;

          ⑥ There is evidence within the first 6 months of enrollment that the patient has other diseases or physiological conditions that may interfere with the evaluation results of this trial, or complications that seriously endanger life, including but not limited to uncontrolled infections, pulmonary arterial hypertension, severe heart failure (NYHA grades III and IV), unstable angina or acute myocardial infarction, poorly controlled refractory hypertension (based on hospitalization medical records diagnosis), etc;

          ⑦ Individuals with mental or neurological disorders who are unable to express their wishes correctly;

          ⑧ Individuals who have had active malignant solid tumors within the past 5 years prior to participating in this study, except for cervical cancer, localized prostate cancer in situ, and non melanoma skin cancer that have been cured;

          ⑨ Have participated in or are currently participating in other clinical trials within one month prior to enrollment;

          ⑩ Researchers have determined that individuals are not suitable to participate in this clinical trial.

Where this trial is running

Suzhou, Jiangsu and 1 other locations

• the First Affiliated Hosptital of Soochow University — Suzhou, Jiangsu, China (Recruiting)
• Ruijin Hospital, Shanghai Jiaotong University School of Medicine — Shanghai, Shanghai Municipality, China (Recruiting)

Study contacts

• Study coordinator: Jia Chen, MD, PhD

Conditions Acute Myeloid Leukemia; FLT3-ITD Mutation; Allogeneic Hematopoietic Cell Transplantation; Maintenance Therapy; Gilteritinib; Sorafenib; Allogeneic Hematopoietic Cell Transplantatio; Maintenance therapy