1. Allogeneic Stem Cell Transplantation Improves Survival in Patients with Acute Myeloid Leukemia Characterized by a High Allelic Ratio of Mutant FLT3-ITD.
- Author
-
Ho, Anthony D., Schetelig, Johannes, Bochtler, Tilmann, Schaich, Markus, Schäfer-Eckart, Kerstin, Hänel, Mathias, Rösler, Wolf, Einsele, Hermann, Kaufmann, Martin, Serve, Hubert, Berdel, Wolfgang E., Stelljes, Matthias, Mayer, Jiri, Reichle, Albrecht, Baldus, Claudia D., Schmitz, Norbert, Kramer, Michael, Röllig, Christoph, Bornhäuser, Martin, and Thiede, Christian
- Subjects
- *
STEM cell transplantation , *GRAFT versus host disease , *ACUTE myeloid leukemia , *ALLELES , *GENETIC mutation , *PATIENTS - Abstract
Allogeneic hematopoietic cell transplantation (alloHCT) as a postremission therapy in patients with FLT3-ITD –positive intermediate-risk acute myeloid leukemia (AML) remains controversial. FLT3-ITD mutations are heterogeneous with respect to allelic ratio, location, and length of the insertion, with a high mutant-to-wild-type ratio consistently associated with inferior prognosis. We retrospectively analyzed the role of alloHCT in first remission in relationship to the allelic ratio and presence or absence of nucleophosmin 1 mutations ( NPM1 ) in the Study Alliance Leukemia AML2003 trial. FLT3-ITD mutations were detected in 209 patients and concomitant NPM1 mutations in 148 patients. Applying a predefined cutoff ratio of .8, AML was grouped into high- and low-ratio FLT3-ITD AML (HR FLT3-ITD and LR FLT3-ITD ). Sixty-one patients (29%) were transplanted in first remission. Overall survival (OS) (HR, .3; 95% CI, .16 to .7; P = .004) and event-free survival (EFS) (HR, .4; 95% CI, .16 to .9; P = .02) were significantly increased in patients with HR FLT3-ITD AML who received alloHCT as consolidation treatment compared with patients who received consolidation chemotherapy. Patients with LR FLT3-ITD AML and wild-type NPM1 who received alloHCT in first remission had increased OS (HR, .3; 95% CI, .1 to .8; P = .02) and EFS (HR, .2; 95% CI, .1 to .8; P = .02), whereas alloHCT in first remission did not have a significant impact on OS and EFS in patients with LR FLT3-ITD AML and concomitant NPM1 mutation. In conclusion, our results provide additional evidence that alloHCT in first remission improves EFS and OS in patients with HR FLT3-ITD AML and in patients with LR FLT3-ITD AML and wild-type NPM1 . [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF