Acute Kidney Injury Possibly Due to the FLT3 Inhibitor Gilteritinib in a Patient with Refractory Acute Myeloid Leukemia: a Case Report

The mutation of FMS-like tyrosine kinase 3 (FLT3) is one of the most common driver mutations seen in acute myeloid leukemia (AML) The prognosis of patients with FLT3 mutation AML is poor. The FLT3 inhibitor gilteritinib is now available for FLT3 mutation relapsed/refractory AML. The overall response to gilteritinib against FLT3 mutation relapsed/refractory AML is approx. 50%. The major side effects of gilteritinib are diarrhea, hepatic transaminase elevation, and cytopenia. Acute kidney injury is detected in less than one-fifth of the patients. All of the reported adverse events related to kidney injury are limited to grades 1 and 2, whereas grade 3 or worse adverse events of creatinine elevation are quite rare. Here, we provide the first report of a severe acute kidney injury that may be due to gilteritinib treatment in a patient for whom temporary hemodialysis was required. Our patient might have had renal dysfunction before the administration of gilteritinib due to previous treatments. It is important to recognize this rare but critical adverse effect, because gilteritinib is being used for previously extensively treated AML patients.