Mild chronic graft-versus-host disease may alleviate poor prognosis associated with FLT3 internal tandem duplication for adult acute myeloid leukemia following allogeneic stem cell transplantation with myeloablative conditioning in first complete remission: a retrospective study.
Internal tandem duplication (ITD) of the FLT3 gene (Fms-like tyrosine kinase 3) is the most commonly found mutation in acute myeloid leukemia (AML). The significance of FLT3-ITD at diagnosis was retrospectively estimated for allo-HSCT (allogeneic hematopoietic stem cell transplantation) outcomes in 140 patients, median age of 38, undergoing allo-HSCT after myeloablative conditioning in first complete remission of AML. FLT3-ITD was detected at AML diagnosis in 42/140 (30%) of included into this study patients. At 3 years, relapse incidence (RI) following allo-HSCT in AML patients with intermediate or normal karyotype was significantly higher in those FLT3-ITD positive than FLT3-ITD negative [52.9 vs. 20.4%, P = 0.002]. Additionally, patients with mild chronic graft-versus-host disease (cGvHD) had significantly lower RI compared to patients with moderate or severe grade cGvHD or those not experiencing cGvHD, respectively, 4.8 vs. 36.0 vs. 27.8%, P = 0.032. FLT3-ITD was harboring a poor prognosis in AML with intermediate or normal karyotype and significantly increased risk of relapse following allo-HSCT. It appears that allo-HSCT does not cure patients with FLT3-ITD, unless they develop symptoms of mild cGvHD and graft versus leukemia, which may decrease RI.
Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
Barbara
B
Nasilowska-Adamska
University of Medical Sciences, Poznan, Poland.
Anna
A
Czyz
School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
Miroslaw
M
Markiewicz
Military Institute of Medicine, Warsaw, Poland.
Piotr
P
Rzepecki
Collegium Medicum of Jagiellonian University, Krakow, Poland.
Beata
B
Piatkowska-Jakubas
Medical University, Warsaw, Poland.
Monika
M
Paluszewska
School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
Monika
M
Dzierzak-Mietla
Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
Iwona
I
Solarska
Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
Katarzyna
K
Borg
Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
Monika
M
Prochorec-Sobieszek
Hammersmith Hospital, London, UK.
Richard
R
Szydlo
University of Medical Sciences, Poznan, Poland.
Krzysztof
K
Lewandowski
Collegium Medicum of Jagiellonian University, Krakow, Poland.
Aleksander
A
Skotnicki
Medical University, Warsaw, Poland.
Wieslaw Wiktor
WW
Jedrzejczak
School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
Slawomira
S
Kyrcz-Krzemien
University of Medical Sciences, Poznan, Poland.
Mieczyslaw
M
Komarnicki
Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
Krzysztof
K
Warzocha
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D020440:Gene Duplication; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000235:genetics* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D020080:Tandem Repeat Sequences; D014178:Translocation, Genetic; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D055815:Young Adult; D051941:fms-Like Tyrosine Kinase 3 / Q000235:genetics*
D051941:fms-Like Tyrosine Kinase 3
FLT3-ITD; acute myeloid leukemia; allo-hematopoietic stem cell transplantation; chronic GvHD