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. 2011 Sep;17(9):1404-9.
doi: 10.1016/j.bbmt.2011.02.003. Epub 2011 Feb 13.

Role of allogeneic transplantation for FLT3/ITD acute myeloid leukemia: outcomes from 133 consecutive newly diagnosed patients from a single institution

Amy E DeZern  1 , Anthony Sung, Sharon Kim, B Douglas Smith, Judith E Karp, Steven D Gore, Richard J Jones, Ephraim Fuchs, Leo Luznik, Michael McDevitt, Mark Levis
Affiliations

Role of allogeneic transplantation for FLT3/ITD acute myeloid leukemia: outcomes from 133 consecutive newly diagnosed patients from a single institution

Amy E DeZern et al. Biol Blood Marrow Transplant. 2011 Sep.

Abstract

Acute myelogenous leukemia (AML) patients with FLT3/ITD mutations have an inferior survival compared to AML patients with wild-type (WT) FLT3, primarily because of an increased relapse rate. Allogeneic transplantation represents a postremission therapy that is effective at reducing the risk of relapse for many cases of poor-risk AML. Whether or not allogeneic transplantation in first complete remission (CR) can improve outcomes for patients with FLT3/ITD AML remains controversial. Our institution has adopted a policy of pursuing allogeneic transplantation, including the use of alternate donors, for FLT3/ITD AML patients in remission. As part of an instituional review board-approved study, we performed a review of the clinical data from November 1, 2004, to October 31, 2008, on all adult patients under the age of 60 presenting in consecutive fashion to the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins with newly diagnosed non-M3 AML. We followed their outcomes through August 1, 2010. During the study period, 133 previously untreated AML patients between the ages of 20 and 59 were diagnosed and received induction and consolidation therapy at our institution. Of these 133 patients, 31 (23%) harbored an FLT3/ITD mutation at diagnosis. The median overall survival (OS) from the time of diagnosis for the FLT3/ITD AML patients was compared to the OS of the entire cohort and found to be comparable (19.3 months versus 15.5 months, P = .56). Historically, OS for FLT3/ITD AML patients is significantly worse than for AML patients lacking this mutation. However, the OS for the 31 FLT3/ITD patients reported here was comparable to the 102 patients with WT FLT3 over the same 4-year time period. One difference that might have contributed to the surprising outcomes for the FLT3/ITD group is our aggressive pursuit of allogeneic bone marrow transplant (BMT) in CR1 within this group (60% of FLT3/ITD versus 17% with WT). Our single-institution study of consecutively treated AML patients supports the hypothesis that allogeneic transplant in early CR1 improves the long-term outcomes for FLT3/ITD AML.

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Figures

Figure 1
Figure 1
Patient Disposition by FLT3/ITD Mutation Status and Treatment
Figure 2
Figure 2
Overall Survival of 133 Patients by FLT3/ITD Mutation Status
Figure 3
Figure 3
Event Free Survival of FLT3/ITD Patients transplanted in CR1
Figure 4
Figure 4
Overall survival of FLT3/ITD and WT patients transplanted versus no transplant
See this image and copyright information in PMC

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