Notice: Users may be experiencing issues with displaying some pages on stanfordhealthcare.org. We are working closely with our technical teams to resolve the issue as quickly as possible. Thank you for your patience.
 

Learn about the flu shot, COVID-19 vaccine, and our masking policy »

Stanford Health Care

Impact of NPM1/FLT3-ITD genotypes defined by the2017 European LeukemiaNet in patients with acute myeloid leukemia. Blood Döhner, K. n., Thiede, C. n., Jahn, N. n., Panina, E. n., Gambietz, A. n., Larson, R. A., Prior, T. W., Marcucci, G. n., Jones, D. n., Krauter, J. n., Heuser, M. n., Voso, M. T., Ottone, T. n., Nomdedeu, J. F., Mandrekar, S. J., Klisovic, R. n., Wei, A. H., Sierra, J. n., Sanz, M. A., Brandwein, J. n., de Witte, T. M., Jansen, J. H., Niederwieser, D. n., Appelbaum, F. n., Medeiros, B. C., Tallman, M. S., Schlenk, R. F., Ganser, A. n., Serve, H. n., Ehninger, G. n., Amadori, S. n., Gathmann, I. n., Benner, A. n., Pallaud, C. n., Stone, R. M., Döhner, H. n., Bloomfield, C. D. 2019

Abstract

Patients with AML harboring FLT3 internal tandem duplications (ITD) have poor outcomes, in particular AML with a high ({greater than or equal to}0.5) mutant-to-wildtype allelic ratio (AR). The 2017 European LeukemiaNet (ELN) recommendations defined four distinct FLT3-ITD genotypes based on the ITD-AR and the NPM1 mutational status. In this retrospective, exploratory study, we investigated the prognostic and predictive impact of the NPM1/FLT3-ITD genotypes categorized according to the 2017 ELN risk groups in patients randomized within the RATIFY trial evaluating the addition of midostaurin to standard chemotherapy. The four NPM1/FLT3-ITD genotypes significantly differed with regard to clinical and concurrent genetic features. Complete ELN risk categorization could be done in 318 of 549 trial patients with FLT3-ITD AML. Significant factors for response after one or two induction cycles were ELN risk group and white blood cell (WBC) counts; treatment with midostaurin had no influence. Overall survival (OS) differed significantly between ELN risk groups with estimated 5-year OS probabilities of 0.63, 0.43, and 0.33 for favorable-, intermediate- and adverse-risk groups, respectively (P<0.001). Multivariate Cox model for OS using allogeneic hematopoietic-cell transplantation (HCT) in first complete remission as a time-dependent variable revealed treatment with midostaurin, allogeneic HCT, ELN favorable-risk group, and lower WBC counts as significant favorable factors. In this model, there was a consistent beneficial effect of midostaurin across ELN risk groups.

View details for DOI 10.1182/blood.2019002697

View details for PubMedID 31826241