Patients with FLT3-mutated acute myeloid leukemia (AML) have a poor prognosis. The choice of the most optimal therapy is an actual problem. To compare the efficacy, safety, and survival rates of salvage intensive chemotherapy (IC) and targeted therapy in patients with FLT3-mutated relapsed/refractory (R/R) AML. A retrospective study was conducted, which included patients with FLT3-mutated R/R AML. Patients received IC (FLAG±Ida) or gilteritinib (as monotherapy or in combination with venetoclax, azacitidine). All patients received inpatient treatment. The study included 24 patients (12 women, 12 men) with a median age of 42 years (18-83 years); 54.2% (13/24) had relapsed and 45.8% (11/24) had refractory AML. Of the 13 relapsed patients, 8 (61.5%) had early relapse. Thirteen patients received IC and 11 patients received gilteritinib (5 as monotherapy, 2 in combination with venetoclax, 4 in combination with venetoclax and azacitidine). Some patients received salvage IC therapy; others received gilteritinib therapy. Overall response rates (CR, CRMRD-; CRi, MFLS) did not differ significantly between the two groups (63% in the gilteritinib group and 60% in the IC group). The median time to remission was shorter in the IC group than in the gilteritinib group (0.8 vs. 1.5 months, respectively). There was no early mortality in the gilteritinib group; in the IC group, it was 23% (3/11). Serious adverse events were more common in the IC group than in the gilteritinib group (61.5% vs. 18.1%, respectively, P=0.032). In the gilteritinib group, more patients underwent allogeneic bone marrow transplantation (BMT) (77.7% vs. 58.3%). The overall survival and relapse-free survival were longer in the gilteritinib group than in the IC group (20.4 vs. 15.3 months; 7.9 vs. 3.37 months, respectively). Gilteritinib therapy is comparable in efficacy to salvage IC in patients with FLT3-mutated R/R AML but has been shown to be safer and have better survival rates. Gilteritinib is an optimal bridge therapy to allogeneic BMT.