Section of Hematology and Stem Cell Transplantation, Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
Bone Marrow Transplant. 2012 Dec;47(12):1535-7. doi: 10.1038/bmt.2012.88. Epub 2012 Jun 4.
Seventy-nine patients with AML in CR1 received allo-SCT between May 2006 and May 2011, and the prognostic impact of FMS-like tyrosine kinase 3/internal tandem duplication (FLT3/ITD) mutation was evaluated in the context of other clinical prognostic factors. Patients with FLT3/ITD + AML had significantly inferior DFS (2-year DFS: 19% vs 64%, P = 0.0027), increased risk of relapse (1-year: 59% vs 19%, P = 0.01), and a trend towards decreased OS (P = 0.08) compared with patients without FLT3/ITD. Multivariate analysis confirmed FLT3/ITD + independently predicted a shorter DFS (HR, 3.0; 95% CI), 1.4-6.5; P = 0.01) and increased risk of relapse (HR, 4.9; 95% CI, 2.0-12.3, P = 0.01). Time to relapse in patients with FLT3/ITD + was short with 100-day cumulative risk of 45% (95% CI, 33-57). Our data suggest that the poor prognostic implication of FLT3/ITD positivity remains even after early allo-SCT in patients with FLT3/ITD + AML, and patients remain at high risk of early relapse. FLT3/ITD positivity also outweighs other conventional prognostic markers in predicting relapse.
79 例 CR1 期 AML 患者于 2006 年 5 月至 2011 年 5 月期间接受 allo-SCT，评估 FMS 样酪氨酸激酶 3/内部串联重复（FLT3/ITD）突变与其他临床预后因素在allo-SCT 中的预后影响。FLT3/ITD+AML 患者的DFS（2 年 DFS：19% vs 64%，P = 0.0027）显著降低，复发风险增加（1 年：59% vs 19%，P = 0.01），OS 降低（P = 0.08），与未发生 FLT3/ITD 的患者相比。多变量分析证实 FLT3/ITD+独立预测较短的 DFS（HR，3.0；95%CI），1.4-6.5；P = 0.01）和更高的复发风险（HR，4.9；95%CI，2.0-12.3，P = 0.01）。FLT3/ITD+患者的复发时间短，100 天累积风险为 45%（95%CI，33-57）。我们的数据表明，即使在 FLT3/ITD+AML 患者接受早期 allo-SCT 后，FLT3/ITD 阳性仍具有不良预后意义，患者仍处于早期复发的高风险中。FLT3/ITD 阳性在预测复发方面比其他传统预后标志物更为重要。
