TUESDAY, March 21, 2023 (HealthDay News) — For patients with acute myeloid leukemia (AML) in first remission prior to allogeneic hematopoietic cell transplant, specific variants can identify patients at risk for increased relapse and worse survival, according to a study published in the March 7 issue of the Journal of the American Medical Association.

Laura W. Dillon, Ph.D., from the U.S. National Institutes of Health in Bethesda, Maryland, and colleagues conducted a retrospective observational study in which DNA sequencing was performed on pretransplant blood from patients aged 18 years or older who had undergone their first allogeneic hematopoietic cell transplant during first remission for AML associated with variants in FLT3, NPM1, IDH1, IDH2, or KIT from 2013 through 2019.

Of the 1,075 patients included, 822 had FLT3 internal tandem duplication (FLT3-ITD) and/or NPM1 mutated AML. The persistence of NPM1 and/or FLT3-ITD variants in the blood of 64 of 371 patients (17.3 percent) in the discovery cohort in remission before undergoing transplant was associated with worse outcomes after transplant. Similarly, 17.3 percent of the 451 patients in the validation cohort with residual NPM1 and/or FLT3-ITD variants had higher rates of relapse at three years (68 versus 21 percent; hazard ratio, 4.32) and reduced survival at three years (39 versus 63 percent; hazard ratio, 2.43).

“These results show that next generation sequencing-measurable residual disease testing of the blood of patients with FLT3-ITD and/or NPM1 mutated AML in first remission prior to transplant could identify differential risk between individuals otherwise placed in the same baseline risk classification,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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