title: Clinical relevance of molecular aberrations in paediatric acute myeloid leukaemia at first relapse.
abstract: Outcome for relapsed paediatric acute myeloid leukaemia (AML) remains poor. Strong prognostic factors at first relapse are lacking, which hampers optimization of therapy. We assessed the frequency of molecular aberrations (FLT3, NRAS, KRAS, KIT, WT1 and NPM1 genes) at first relapse in a large set (n = 198) of relapsed non-French-American-British M3, non-Down syndrome AML patients that received similar relapse treatment. We correlated molecular aberrations with clinical and biological factors and studied their prognostic relevance. Hotspot mutations in the analysed genes were detected in 92 out of 198 patients (46·5%). In 72 of these 92 patients (78%), molecular aberrations were mutually exclusive for the currently analysed genes. FLT3-internal tandem repeat (ITD) (18% of total group) mutations were most frequent, followed by NRAS (10·2%), KRAS (8%), WT1 (8%), KIT (8%), NPM1 (5%) and FLT3-tyrosine kinase domain (3%) mutations. Presence of a WT1 aberration was an independent risk factor for second relapse (Hazard Ratio [HR] = 2·74, P = 0·013). In patients who achieved second complete remission (70·2%), WT1 and FLT3-ITD aberrations were independent risk factors for poor overall survival (HR = 2·32, P = 0·038 and HR = 1·89, P = 0·045 respectively). These data show that molecular aberrations at first relapse are of prognostic relevance and potentially useful for risk group stratification of paediatric relapsed AML and for identification of patients eligible for personalized treatment.
authors: Department of Haematology, VU University Medical Centre, Amsterdam, The Netherlands; Department of Paediatric Oncology/Haematology, VU University Medical Centre, Amsterdam, The Netherlands.
authors: Costa
authors: C
authors: Bachas
authors: Gerrit Jan
authors: GJ
authors: Schuurhuis
authors: Dirk
authors: D
authors: Reinhardt
authors: Ursula
authors: U
authors: Creutzig
authors: Zinia J
authors: ZJ
authors: Kwidama
authors: C Michel
authors: CM
authors: Zwaan
authors: Marry M
authors: MM
authors: van den Heuvel-Eibrink
authors: Evelina S J M
authors: ES
authors: De Bont
authors: Sarah
authors: S
authors: Elitzur
authors: Carmelo
authors: C
authors: Rizzari
authors: Valérie
authors: V
authors: de Haas
authors: Martin
authors: M
authors: Zimmermann
authors: Jacqueline
authors: J
authors: Cloos
authors: Gertjan J L
authors: GJ
authors: Kaspers
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D052138:Genes, Neoplasm / Q000235:genetics*; D006801:Humans; D007223:Infant; D059785:Karyotype; D015470:Leukemia, Myeloid, Acute / Q000235:genetics* / Q000628:therapy; D008297:Male; D009154:Mutation / Q000235:genetics*; D009363:Neoplasm Proteins / Q000235:genetics*; D000090243:Nucleophosmin; D012008:Recurrence; D012307:Risk Factors
chemical_list: C000716967:NPM1 protein, human; D009363:Neoplasm Proteins; D000090243:Nucleophosmin
keywords: acute myeloid leukaemia; event free survival; mutation analysis; overall survival; relapse