Efficacy and safety of FLT3 inhibitors for acute myeloid leukemia: a network meta-analysis

Background Along with the more and more clinical application of various FLT3 inhibitors in acute myeloid leukemia (AML), their real clinical benefits still remain a debated topic. Therefore, this study uses a network meta-analysis method to make comparison on the treatment efficacy and safety situation of different FLT3 inhibitors, hence aiming to offer evidence-based supporting materials for the selection work of clinical treatment strategies. Methods A systemic search action was carried out inside PubMed, Web of Science, Cochrane Library, and Embase, from the starting time of each database until December 17, 2025, for the aim to find randomized controlled trials of FLT3 inhibitors used for AML treatment. Stata 18.0 and R Studio software were applied to conduct network meta-analysis, hence RevMan 5.4 software was utilized to perform literature quality appraisal and bias risk assessment. Results Twenty RCTs with total 6128 acute myeloid leukemia patients are contained. Efficacy comparison outcomes have demonstrated that treatment with FLT3 inhibitors Gilteritinib (OR = 1.75, 95% CI: 1.16–2.66) and Midostaurin (OR = 1.31, 95% CI: 1.07–1.60) can produce significant improvement in patients’ complete remission rate. Therefore, survival analysis has found that Gilteritinib (HR = 0.70, 95% CI: 0.49–0.99) and Quizartinib (HR = 0.73, 95% CI: 0.54–0.98) can significantly prolong patients’ overall survival (OS). Thus, safety evaluation results have shown that, compared with the control group, the experimental group bears significantly higher risk of adverse events including reduced neutrophil count, anemia, elevated alanine aminotransferase, elevated aspartate aminotransferase, fatigue, thrombocytopenia, dyspnea, and neutropenia ( P < 0.05). Conclusions The investigation outcomes of this research demonstrate that FLT3 inhibitors can produce effective prolongation of overall survival (OS) and bring about improvement to complete remission rate (CR) in AML patients, with good safety and tolerability performance; therefore, hence, gilteritinib may show more excellent treatment effectiveness among them. Systematic review registration , identifier CRD420251267673.