Abhinav Deol1, Salyka Sengsayadeth2, Kwang Woo Ahn3,4, Hai-Lin Wang3, Mahmoud Aljurf5, Joseph Harry Antin6, Minoo Battiwalla7, Martin Bornhauser8, Jean-Yves Cahn9, Bruce Camitta10, Yi-Bin Chen11, Corey S Cutler6, Robert Peter Gale12, Siddhartha Ganguly13, Mehdi Hamadani3, Yoshihiro Inamoto14, Madan Jagasia2, Rammurti Kamble15, John Koreth6, Hillard M Lazarus16, Jane Liesveld17, Mark R Litzow18, David I Marks19, Taiga Nishihori20, Richard F Olsson21,22, Ran Reshef23, Jacob M Rowe24, Ayman A Saad25, Mitchell Sabloff26, Harry C Schouten27, Thomas C Shea28, Robert J Soiffer6, Geoffrey L Uy29, Edmond K Waller30, Peter H Wiernik31, Baldeep Wirk32, Ann E Woolfrey33, Donald Bunjes34, Steven Devine35, Marcos de Lima36, Brenda M Sandmaier37, Dan Weisdorf38, Hanna Jean Khoury30, Wael Saber3. 1. Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI. 2. Vanderbilt University Medical Center, Nashville, TN. 3. CIBMTR, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI. 4. Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI. 5. Department of Oncology, King Faisal Specialist Hospital Center & Research, Riydah, Saudi Arabia. 6. Center for Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA. 7. Hematology Branch, National Heart Lung and Blood Institute, Bethesda, MD. 8. Universitatsklinikum Carl Gustav Carus, Dresden, Germany. 9. Department of Hematology, University Hospital, Grenoble, France. 10. Midwest Center for Cancer and Blood Disorders, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI. 11. Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA. 12. Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom. 13. Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS. 14. Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan. 15. Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX. 16. Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH. 17. Department of Medicine, University of Rochester Medical Center, Rochester, NY. 18. Division of Hematology and Transplant Center, Mayo Clinic Rochester. 19. Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom. 20. Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL. 21. Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden. 22. Centre for Clinical Research, Sormland, Uppsala University, Uppsala, Sweden. 23. Blood and Marrow Transplantation Program and Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY. 24. Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel. 25. Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL. 26. Division of Hematology, Department of Medicine, University of Ottawa and Ottawa Hospital Research institute, Ottawa, Canada. 27. Department of Hematology, Academische Ziekenhuis, Maastricht, Netherlands. 28. Division of Hematology and Oncology, Department of Medicine, University of North Carolina Health Care, Chapel Hill, NC. 29. Divsion of Onocology, Washington University School of Medicine, St. Louis, MO. 30. Department of Hematology and Medical Oncology, Winship Cancer Insitute, Emory University, Atlanta, GA. 31. Our Lady of Mercy Medical Center, Bronx, NY. 32. Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA. 33. Fred Hutchinson Cancer Research Center, Seattle, WA. 34. Department of Internal Medicine III, Universitatsklinkum Ulm, Ulm, Germany. 35. Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center- James, Columbus, OH. 36. Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH. 37. Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA. 38. CIBMTR, NMDP/ Be The Match, Minneapolis, MN.
Abstract
BACKGROUND: Patients with FMS like tyrosine kinase 3 (FLT3)-mutated acute myeloid leukemia (AML) have a poor prognosis and are referred for early allogeneic hematopoietic stem cell transplantation (HCT). METHODS: Data from the Center for International Blood and Marrow Transplant Research (CIBMTR) were used to evaluate 511 adult patients with de novo AML who underwent HCT during 2008 through 2011 to determine whether FLT3 mutations had an impact on HCT outcomes. RESULTS: In total, 158 patients (31%) had FLT3 mutations. Univariate and multivariate analyses revealed an increased risk of relapse at 3 years in the FLT3 mutated group compared with the wild-type (WT) group (38% [95% confidence interval (CI), 30%-45%] vs 28% [95% CI, 24%-33%]; P = .04; relative risk, 1.60 [95% CI, 1.15-2.22]; P = .0048). However, FLT3 mutation status was not significantly associated with nonrelapse mortality, leukemia-free survival, or overall survival. Although more patients in the FLT3 mutated group died from relapsed primary disease compared with those in the WT group (60% vs 46%), the 3-year overall survival rate was comparable for the 2 groups (mutated group: 49%; 95% CI, 40%-57%; WT group: 55%, 95% CI, 50%-60%; P = .20). CONCLUSIONS: The current data indicate that FLT3 mutation status did not adversely impact overall survival after HCT, and about 50% of patients with this mutation who underwent HCT were long-term survivors. Cancer 2016;122:3005-3014.
BACKGROUND:Patients with FMS like tyrosine kinase 3 (FLT3)-mutated acute myeloid leukemia (AML) have a poor prognosis and are referred for early allogeneic hematopoietic stem cell transplantation (HCT). METHODS: Data from the Center for International Blood and Marrow Transplant Research (CIBMTR) were used to evaluate 511 adult patients with de novo AML who underwent HCT during 2008 through 2011 to determine whether FLT3 mutations had an impact on HCT outcomes. RESULTS: In total, 158 patients (31%) had FLT3 mutations. Univariate and multivariate analyses revealed an increased risk of relapse at 3 years in the FLT3 mutated group compared with the wild-type (WT) group (38% [95% confidence interval (CI), 30%-45%] vs 28% [95% CI, 24%-33%]; P = .04; relative risk, 1.60 [95% CI, 1.15-2.22]; P = .0048). However, FLT3 mutation status was not significantly associated with nonrelapse mortality, leukemia-free survival, or overall survival. Although more patients in the FLT3 mutated group died from relapsed primary disease compared with those in the WT group (60% vs 46%), the 3-year overall survival rate was comparable for the 2 groups (mutated group: 49%; 95% CI, 40%-57%; WT group: 55%, 95% CI, 50%-60%; P = .20). CONCLUSIONS: The current data indicate that FLT3 mutation status did not adversely impact overall survival after HCT, and about 50% of patients with this mutation who underwent HCT were long-term survivors. Cancer 2016;122:3005-3014.
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