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CC BY 4.0 · Indian J Med Paediatr Oncol
DOI: 10.1055/s-0043-1772255
Case Report with Review of Literature

Recurrent Hyperbilirubinemia with Midostaurin during Consolidation in a Patient of AML with FLT3 Mutation and Review of Literature for Alternative Maintenance Strategy

Deepak Kumar Shukla
1   Consultant Medical Oncologist, Manipal Hospital, Jaipur, Rajasthan, India
,
Satyendra Katewa
2   Consultant Pediatric Hemato-oncologist and BMT Physician, Manipal Hospital, Jaipur, Rajasthan, India
,
Ravikant Porwal
3   Consultant Infectious Disease, Manipal Hospital, Jaipur, Rajasthan, India
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Abstract

Midostaurin-induced hyperbilirubinemia during consolidation chemotherapy is uncommon. Dose-modification strategy for midostaurin in presence of hyperbilirubinemia remains undefined. We report a case of a young woman diagnosed as acute myeloid leukemia having normal cytogenetics with FLT3-ITD (internal tandem duplication) mutation who tolerated midostaurin during induction but developed recurrent hyperbilirubinemia without transaminitis with midostaurin during high-dose cytarabine consolidation. The pattern of hyperbilirubinemia with midostaurin was transient and rapidly reversible on stopping the drug, but recurred thrice. Sanger sequencing for UGT1A1*28 polymorphism failed to detect relevant variations. In the absence of any other approved FLT3 inhibitor in first line setting, she received sorafenib maintenance at 200 mg twice daily in combination with subcutaneous azacitidine. The combination was well tolerated without hyperbilirubinemia with sorafenib.

Key Messages:

► Safety of sorafenib in the setting of recurrent hyperbilirubinemia with midostaurin is not known. In this case report the combination of sorafenib with parenteral azacitidine was well tolerated without recurrence of hyperbilirubinemia.

Keywords

AML - FLT3 mutation - midostaurin - hyperbilirubinemia - sorafenib

Patient's Consent

Written informed consent was taken from patient for publishing the case report.


Authors' Contributions

D.S. was involved in conceptualization, methodology, and writing.


S.K. was involved in supervision and writing.


R.P. helped in data curation and editing.




Publikationsverlauf

Artikel online veröffentlicht:
08. Mai 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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