Influence of FLT3-ITD Mutation and ITD Length on the Outcome on Patients with Acute Myeloid Leukemia.

Fang Chen; Xue-jie Jiang; Chang-xin Yin; Qing-xiu Zhong; Ling Jiang; Guo-pan YU; Jing Sun; Fan-yi Meng

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Influence of FLT3-ITD Mutation and ITD Length on the Outcome on Patients with Acute Myeloid Leukemia.

Author: Fang CHEN ¹ ; Xue-Jie JIANG ¹ ; Chang-Xin YIN ¹ ; Qing-Xiu ZHONG ² ; Ling JIANG ¹ ; Guo-Pan YU ¹ ; Jing SUN ¹ ; Fan-Yi MENG ^{3
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Author Information

1. Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
2. Department of Hematology, Kanghua Hospital, Dongguan 523080, Guangdong Province, China.
3. Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
4. Department of Hematology, Kanghua Hospital, Dongguan 523080, Guangdong Province, China. E-mail: mengfu@medmail.com.cn.
Publication Type:Journal Article
MeSH: Hematopoietic Stem Cell Transplantation; Humans; Leukemia, Myeloid, Acute; Mutation; Oncogene Proteins, Fusion; Prognosis; Retrospective Studies; fms-Like Tyrosine Kinase 3
From: Journal of Experimental Hematology 2018;26(3):678-683
CountryChina
Language:Chinese
Abstract:
OBJECTIVETo explore the influence of FLT3-ITD mutation and ITD length on the overall survival (OS) and relapse free survival(RFS) in patients with non-M3 acute myeloid leukemia.
METHODSClinical features and therapeutic effect were retrospectively analyzed in 75 AML patients with FLT3-ITD mutation and 76 FLT3-ITD AML patients with a normal karotype from June 2011 to April 2016. Genomic DNA was amplified by PCR, and FLT3-ITD mutation length was analyzed by DNA sequencing in 40 patients.
RESULTSAML patients with FLT3-ITD mutation had higher WBC count and the ratio of BM blast cells at initial diagnosis was also higher than those in AML patients without FLT3-ITD mutation (95.13 vs 10.85)(P<0.01); 72% vs 59%(P<0.01). The CR rates in AML patients with FLT3-ITD mutation less than those in AML patients without FLT3-ITD mutation(70.42% vs 94.7%)(P<0.01). OS (P<0.01) and RFS (P<0.01) were significantly increased in patients with AML who received allo-HSCT as compared with the patients who received consolidation chemotherapy and similar to AML patients without FLT3-ITD mutation who received HSCT. Patients with maintenance sorafenib after HSCT had longer OS (P<0.05) and RFS (P<0.05) than controls. ITDs exceeding 60 bp in length were associated with decreasing OS as compared with shorter ITD in AML patients with FLT3-ITD mutation (P<0.05). OS and RFS were similar among the 2 groups receiving consolidation chemotherapy. Besides, the patients with allo-HSCT had shorter ITDs and longer OS than ITDs exceeding 60 bp (P<0.05) and similar to AML patients without FLT3-ITD mutation.
CONCLUSIONAML patients with FLT3-ITD mutation has poorer outcome, among which the prognosis was worse in patients with ITD exceeding 60 bp, and the chemotherapy alone can not improve the prognosis of FLT3-ITD. Allo-HSCT is an effective treatment for AML patients with FLT3-ITD mutation; Sorafenib appears to be an effective maintenance therapy after allo-HSCT in FLT3-ITD AML.