Comparison of autologous stem cell transplantation versus consolidation chemotherapy for patients with cytogenetically normal acute myeloid leukemia (CN-AML) and FLT3ITD.

We retrospectively analyzed clinical outcomes of patients aged 18–59 with cytogenetically normal AML (CN-AML) and mutations in the FLT3 receptor according to type of postremission therapy. Specifically, we compared the outcomes of patients who underwent autologous SCT versus consolidation chemotherapy. There were 37 patients with an ITD mutation (7 also had a TKD mutation) and 19 patients with an isolated TKD mutation at diagnosis. In all, patients with an isolated TKD (n=16) had an improved DFS and OS (p=.031 and .014, respectively) compared to ITD patients (n=21). For individuals with an isolated TKD mutation, survival outcomes were similar irrespective of the type of postremission therapy (n=7 for SCT and 9 for chemotherapy) (p=0.97 and 0.082, respectively). However, ITD positive patients who underwent an SCT in CR1 (n=10) had an improved DFS but similar OS compared to those who received consolidation chemotherapy (n=11) (p=.05 and .27). These results suggest that high dose chemotherapy with autologous SCT may be a reasonable therapeutic choice over consolidation chemotherapy for young CN-AML patients with a FLT3ITD mutation.