Midostaurin Nursing perspectives on managing treatment and adverse events in patients with FLT3 mutation-positive acute myeloid leukemia and advanced systemic mastocytosis

BACKGROUND: Acute myeloid leukemia (AML) and advanced systemic mastocytosis (SM) are clonal diseases of the blood. Prognoses for patients with FMS-like tyrosine kinase 3 (FLT3) mutation-positive AML and those with advanced SM are poor. In the United States, midostaurin was approved in 2017 in combination with standard chemotherapy in patients with newly diagnosed FLT3 mutation-positive AML and as a single agent in patients with advanced SM. OBJECTIVES: This article aims to improve oncology nurses' knowledge about the benefits and risks of midostaurin therapy and to provide guidance on the identification and management of eligible patients. METHODS:The clinical data that supported the U.S. Food and Drug Administration's approval of midotaurin are reviewed, and supporting safety and management considerations are provided based on the authors' experiences as nurses and advanced practice providers caring for patients who received midostaurin during these key clinical trials. FINDINGS: Nausea and vomiting are the most frequent nonhematologic adverse events reported with midostaurin; therefore, administer midostaurin with antiemetics, and recommend taking it with food. Care should be taken when midostaurin is coadministered with strong CYP3A4 inhibitors.