Improved outcomes among newly diagnosed patients with FMS-like tyrosine kinase 3 internal tandem duplication mutated acute myeloid leukemia treated with contemporary therapy: Revisiting the European LeukemiaNet adverse risk classification

Autor: Patrick K, Reville, Koji, Sasaki, Hagop M, Kantarjian, Naval G, Daver, Musa, Yilmaz, Courtney D, Dinardo, Nicholas J, Short, Gautam, Borthakur, Naveen, Pemmaraju, Rohtesh S, Mehta, Sherry, Pierce, Sergej N, Konoplev, Joseph D, Khoury, Guillermo, Garcia-Manero, Marina Y, Konopleva, Elias, Jabbour, Farhad, Ravandi, Tapan M, Kadia
Rok vydání: 2021
Předmět:
Zdroj: Am J Hematol
ISSN: 1096-8652
Popis: Mutations in in fms-like tyrosine kinase 3 (FLT3) gene are common genomic alterations in acute myeloid leukemia (AML). FLT3 internal tandem duplication mutations (FLT3-ITD) have consistently been shown to be adversely prognostic, particularly those with high allelic ratio. Current AML treatment strategies including high dose cytarabine, purine analogs, FLT3 inhibitors (FLT3i), and with or without allogeneic stem cell transplant (SCT) have been shown to improve the outcomes in patients with FLT3 mutations. We analyzed a consecutive cohort of newly diagnosed patients with AML treated at a large academic medical center from January 2012 through January 2020. A total of 1576 patients with a new diagnosis of AML were reviewed. Among these, 1,438 (91%) had molecular testing for FLT3 mutations and 21% (304/1,438) had a FLT3 mutation, including 17% with a FLT3-ITD mutation. We show that FLT3-ITD high allelic ratio with NPM1 wild-type have significantly improved survival compared with other European LeukemiaNet (ELN) adverse risk disease. In multivariable cox proportional hazards model of patients receiving intensive or low intensity induction regimens, FLT3 mutations did not have prognostic significance. The use of allogeneic stem cell transplant in CR1 for patients with FLT3 mutations appears to improve survival, particularly in those with ELN adverse risk disease. Overall, this data highlights the changing prognostic impact of FLT3 mutations in a contemporary era with appropriate use of induction therapy combined with targeted agents and allogenic stem cell transplant.
Databáze: OpenAIRE
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