| ObjectiveCompare the clinical characteristics, reaction to therapy and prognosis between fns-like tyrosine kinase-3-internal tandem duplication (FLT3-ITD) mutation-positive acute myeloid leukemia (AML) patients and FLT3-ITD-negative patients, excluding acute promyelocytic leukemia (APL), and explore the clinical efficacy of different therapeutic regimens.MethodsDuring January2009to December2012,177AML patients in our center were admitted in our study, they were divided into two groups by FLT3-ITD mutations: FLT3-ITD mutation-positive (FLT3-ITD+) and FLT3-ITD mutation-negative (FLT3-ITD-). We assessed clinical characteristics, response to induction chemotherapy, first year overall survival (1-OS), first year event-free survival (1-EFS),2-OS and 2-EFS. Then to compare the prognosis of refractory leukemia and no-refractory leukemia between two groups, and explore the prognosis of FLT3-ITD+AML patients with or without NPM1mutations, and compare curative effect of FLT3-ITD+AML patients with different therapeutic regimens.ResultsOne hundred seventy-seven patients with AML excluding APL received induction chemotherapy in multi-centers. FLT3-ITD-postive mutation was detected in83patients, and94patients with FLT3-ITD-negative mutation, and FLT3-ITD+AML patients had higher peripheral blood leukocytes count(≥100×10E9/L) than FLT3-ITD-AML patients(P<0.001), but there are no difference among age, sex and FAB classification between them. Thirty-nine percent patients achieved complete remission (CR) after first induction chemotherapy, were inferior to FLT3-ITD-patients (56%(P=0.036)).1-EFS and2-EFS was also inferior in patients with FLT3-ITD (40%and14.8%vs.60%and38.4%; P=0.018vs.P=0.002), so as to overall survival(including1-OS and2-OS)(P<0.001). In FLT3-ITD+patients,41%patients had NPM1mutation, and the prognosis of FLT3-ITD+/NPM1-patients is superior to FLT3-ITD+/NPM1+patients, moreover, the difference has statistical significance (P=0.026). There was no difference on mortality rate between FLT3-ITD+and FLT3-ITD-AML according to refractory leukemia (P=0.21), so as to overall survival (P=0.171). But the overall survival was worse in FLT3-ITD+/non-refractory patients than FLT3-ITD-/non-refractory patients (P=0.011). Allogeneic hematopoietic stem cell transplantation (allo-HSCT) could improve the overall survival of FLT3-ITD+patients(P>0.001),but no statistical differences between target therapy with Sorafenib and chemotherapy merely (P=0.199) ConclusionsFLT3-ITD+AML patients always had higher peripheral blood leukocytes count, and worse prognosis with shorter CR and EFS. NPM1mutation had significant effect on overall survival of FLT3-ITD+patients. Allo-HSCT could improve prognosis of FLT3-ITD+patients. The benefits of Sorafenib on FLT-ITD+AML should be evaluated on further studies. |
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