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Risk stratification using FLT3 and NPM1 in acute myeloid leukemia patients autografted in first complete remission

Bone Marrow Transplantation volume 55, pages 2244–2253 (2020)Cite this article

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Abstract

FLT3-ITD and NPM1 mutation refine prognostic stratification in acute myeloid leukemia (AML) with intermediate-risk cytogenetics. However, data on their role in patients undergoing autologous stem cell transplantation (Auto-SCT) as post-remission therapy (PRT) are limited. We therefore sought to retrospectively evaluate the role of FLT3-ITD and NPM1 in a cohort of AML patients (n = 405) with intermediate-risk cytogenetics, autografted in first complete remission (CR1). Patients were transplanted between 2000 and 2014 and reported to the European Society for Blood and Marrow Transplantation (EBMT) registry. Leukemia-free survival (LFS) was the primary outcome. Median follow-up was 5.5 years. FLT3-ITDneg/NPM1WT was the leading molecular subtype (50%), followed by FLT3-ITDneg/NPM1mut (30%). In the univariate analysis, molecular subtype was associated with LFS, overall survival (OS), and relapse incidence (RI) (p < 0.001); 5-year LFS: FLT3-ITDneg/NPM1mut 62%, FLT3-ITDpos/NPM1mut 38%, FLT3-ITDneg/NPM1WT 32%, and FLT3-ITDpos/NPM1WT 21%. At 5 years, OS and RI in the FLT3-ITDneg/NPM1mut subtype were 74% and 35%, respectively. The corresponding OS and RI in other subtypes were below 48% and over 57%. In a Cox multivariable model, molecular subtype was the strongest predictor of LFS, OS, and relapse. In conclusion, AML patients with intermediate-risk cytogenetics and FLT3-ITDneg/NPM1mut experience favorable outcomes when autografted in CR1, suggesting that Auto-SCT is a valid PRT option.

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Fig. 1: Outcomes by FLT3-ITD and NPM1 status.

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Acknowledgements

The study was supported by the Varda and Boaz Dotan Research Center in Hemato-oncology, Idea Award Research Grant, Tel-Aviv University.

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Authors and Affiliations

  1. Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Roni Shouval, David Bomze & Arnon Nagler

  2. Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel

    Roni Shouval

  3. Acute Leukemia Working Party of EBMT, Paris, France

    Myriam Labopin & Arnon Nagler

  4. Université Pierre et Marie Curie, Paris, France

    Myriam Labopin

  5. Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    Gabriela M. Baerlocher

  6. Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Policlinico Umberto I, Rome, Italy

    Saveria Capria

  7. Department of Hematology, Institut Paoli Calmettes, Marseille, France

    Didier Blaise

  8. Department of Hematology, Oncology, Stem Cell Transplantation, Hospital Chemnitz, Chemnitz, Germany

    Mathias Hänel

  9. Hématologie Clinique et Thérapie cellulaire, CHU Bordeaux, Pessac, France

    Edouard Forcade

  10. CHU Toulouse, IUCT-Oncopole, Toulouse, France

    Anne Huynh

  11. AOUC Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Riccardo Saccardi

  12. Ospedale Ferrarotto, Catania, Italy

    Giuseppe Milone

  13. Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

    Tsila Zuckerman

  14. St. István and St. László Hospital of Budapest, Budapest, Hungary

    Péter Reményi

  15. Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands

    Jurjen Versluis

  16. Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain

    Jordi Esteve

  17. EBMT Paris study office / CEREST-TC, Saint Antoine Hospital, Paris, France

    Norbert Claude Gorin

  18. Hospital Saint-Antoine, APHP, Sorbonne University, INSERM U938, Paris, France

    Mohamad Mohty

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Shouval, R., Labopin, M., Bomze, D. et al. Risk stratification using FLT3 and NPM1 in acute myeloid leukemia patients autografted in first complete remission. Bone Marrow Transplant 55, 2244–2253 (2020). https://doi.org/10.1038/s41409-020-0936-z

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