What would be your choice for re-induction in a young patient with FLT3+ refractory AML after 7+3 induction therapy with no FLT3 mutation on the day 14 marrow?

I would use a 5+2 regimen with midostaurin and would not put much stock in an absent FLT3 mutation at day 14. If there had been no cytoreduction, some would switch to another chemotherapy regimen but there is little data for that especially in an FLT3+ AML. We are not told what the degree of response was in this case, and the patient would not be deemed refractory until after two inductions have been administered. We are also not told if this was an ITD or TKD mutation which would not change the recommendation to use an FLT3 inhibitor but could have prognostic importance.