Prognostic Significance Of FLT3-ITD Mutation In Acute Myeloid Leukemia Patients Receiving Allogeneic Hematopoietic Stem Cell Transplantation:a Meta Analysis

Objective:It is recognized that FLT3-ITD mutation is a risk factor for AML patients.But the effect of FLT3-ITD mutation in AML patients receiving allogeneic hematopoietic stem cell transplantation is controversial.This topic is to analyze the relationship between FLT3-ITD mutation and prognosis of acute myeloid leukemia(AML)patients receiving allogeneic hematopoietic stem cell transplantation by Meta analysis.Methods:Datebases such as Pubmed,Cochrane,Highwire,CNKI,WanFang Date were searched to collect literatures describing the association between FLT3-ITD mutation and the prognosis of acute myeloid leukemia patients receiving allogeneic hematopoietic stem cell transplantation.The retrieval date was from creating database to October 31,2016.We adopted disease free survival(DFS),overall survival(OS),relapse rate(RR),non-relapse mortality(NRM)as result indicators.The data was input and analysed with Cochrane review manager software(RevMan 5.3)for meta-analyses.Results:A total of 10 study literatures were analyzed,including 1589 cases of subjects,including 465 cases of FLT3-ITD mutation positive(FLT3-ITD+)and 1124 cases of FLT3-ITD mutation negative(FLT3-ITD-)AML patients.Of which 5 study literatures were about normal karyotype-AML patients,including 834 cases of subjects,including291 cases of FLT3-ITD mutation positive(FLT3-ITD+)and 543 cases of FLT3-ITD mutation negative(FLT3-ITD-)AML patients.The meta analysis showed : In all AML patients,The HR for disease free survival(DFS)was1.36(95%CI:1.25~1.48,P<0.00001),the HR for overall survival(OS)was 1.34(95%CI:1.22~1.46,P<0.00001),the HR for relapse rate(RR)was1.64(95%CI:1.48~1.83,P<0.00001),there were statistically significant differences between FLT3-ITD+ and FLT3-ITD-AML patients.indicating that FLT3-ITD mutation is a risk factor in AML patients receiving allogeneic hematopoietic stem cell transplantation.But there was no statistically difference between FLT3-ITD+ and FLT3-ITD-AML patients in non-relapse mortality,the HR for which was 0.80(95%CI: 0.37~1.7,P=0.59).In normal karyotype-AML patients,The HR for disease free survival(DFS)was 1.36(95%CI:1.21~1.52,P<0.00001),the HR for overall survival(OS)was 1.34(95%CI:1.19~1.52,P<0.00001),the HR for relapse rate(RR)was1.61(95%CI:1.40~1.85,P<0.00001),there were statistically significant difference between FLT3-ITD+ and FLT3-ITD-AML patients.indicating that FLT3-ITD mutation is a risk factor in NK-AML patients receiving allogeneic hematopoietic stem cell transplantation.Conclusion:According to the Meta analysis,As total AML,NK-AML subtype patients,FLT3-ITD mutation was a risk factor in DFS,OS,RR.There was no statistically difference between FLT3-ITD+ and FLT3-ITD-AML patients in non-relapse mortality.The result promote that FLT3-ITD mutation is an adverse prognostic factor in AML patients receiving allogeneic hematopoietic stem cell transplantation.Due to the quality and the quantity of the literatures,we need to research further.