Annals of hematology · 2024
Do NPM1 and FLT3-ITD mutations modify prognosis in patients treated with non-intensive regimens?
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Suárez E U, Boluda B, Lavilla E, Tormo M, Botella C, Gil C, Vives S, Rodríguez C, Serrano J, Sayas M J, Martínez-Sánchez P, Ramos F, Bernal T, Algarra L, Bergua-Burgues J M, Pérez-Simón J A, Herrera P, Barrios M, Noriega-Concepción V, Raposo-Puglia J A, Ayala R, Barragán E, Martínez-Cuadrón D, Amigo M L, López-Lorenzo J L, Lázaro-García A, Guimaraes J E, Colorado M, García-Boyero R, De Rueda-Ciller B, Foncillas-García M, Hong A, Labrador J, Alonso-Dominguez J M, Montesinos P, PETHEMA group
Аннотация
FLT3-ITD and NPM1 mutations are key to defining the genetic risk profile of acute myeloid leukemia (AML). We aimed to assess the prognostic features of the FLT3-ITD and NPM1 mutations in old and/or unfit individuals with AML treated with non-intensive therapies in the era before azacitidine-venetoclax approbation. The results of various non-intensive regimens were also compared. We conducted a retrospective analysis that included patients treated with different non-intensive regimens, between 2007 and 2020 from PETHEMA AML registry. We compiled 707 patients with a median age of 74 years and median follow-up time of 37.7 months. FLT3-ITD patients (N = 98) showed a non-significant difference in overall survival (OS) compared to FLT3-ITD negative-patients (N = 608) (P = 0.17, median OS was 5 vs 7.3 months respectively). NPM1-mutated patients (N = 144) also showed a non-significant difference with NPM1 wild type (N = 519) patients (P = 0.25, median OS 7.2 vs 6.8 respectively). In the Cox regression analysis neither NPM1 nor FLT3-ITD nor age were significant prognostic variables for OS prediction. Abnormal karyotype and a high leukocyte count showed a statistically significant deleterious effect. Azacitidine also showed better survival compared to FLUGA (low dose cytarabine plus fludarabine). NPM1 and FLT3-ITD seem to lack prognostic value in older/unfit AML patients treated with non-intensive regimens other than azacitidine-venetoclax combination.