Real-world treatment adherence and persistence of FLT3 inhibitors as post-alloHCT maintenance therapy in patients with AML in the United States: a cohort study using administrative claims data.

In mutated () acute myeloid leukemia (AML), relapse after allogeneic hematopoietic cell transplantation (alloHCT) is the leading cause of treatment failure and mortality. We evaluated real-world adherence and persistence of FLT3-like-tyrosine kinase inhibitors as alloHCT maintenance in AML. Claims data were extracted from adults with AML with ≥1 alloHCT between January 2016 and June 2022 who received gilteritinib, midostaurin, or sorafenib as post-alloHCT maintenance. Adherence (PDC; days covered ≥80% during follow-up) and persistence (days receiving treatment without switch/gap >60 days) were assessed. Of 162 patients, 41, 53, and 68 received post-alloHCT gilteritinib, midostaurin, or sorafenib, respectively. Adherence was higher in patients with a history of relapsed/refractory disease before alloHCT ( = 106 [65.4%],  = .021). Although this study did not focus on outcomes, no significant differences in post-alloHCT relapse by PDC were found. Discontinuation risk was higher for midostaurin (HR = 2.79,  = .0005) and sorafenib (HR = 1.74,  = .046) versus gilteritinib in patients with Commercial insurance vs Medicare/Medicaid (HR = 1.68,  .019).