The Prognostic Effect Of The NPM1 Mutation And The FLT3-ITD Genes In Acute Promyelocytic Leukemia

Abstract

Background: The Nucleophosmin 1 gene mutation (NPM1mut) is considered a favorable clinical outcome in patients with acute myeloid leukemia (AML) with normal chromosome, and this outcome may be reduced with the presence of an internal tandem repeat of the Fms-like tyrosine kinase 3 gene (FLT3-ITD). However, the effect of NPM1mut on patients with acute promyelocytic leukemia (APL) remains unclear. Our objective was to analyze the prognostic effect of the NPM1mut gene and the FLT3-ITD gene in patients with APL. Methods: Sixty patients with new APL diagnoses underwent RT-PCR detection of the NPM1mut and FLT3-ITD genes, and accepted treatment with ATRA and chemotherapy. The presence and combinations of genotypes were compared in association with overall survival (OS) and progression- free survival (PFS) outcome. Results: Twenty- eight patients had positive FLT3-ITD with a rate of 46.7%, nine had positive NPM1mut with a rate of 15%. Patients with FLT3-ITD positive have worse OS and PFS compared to FLT3-ITD negative (p=0.027; 0.008, respectively), but there were no statistically significant differences in OS, PFS between the groups: NPM1mut positive and NPM1mut negative (p=0.209; 0.352, respectively), NPM1mut positive/FLT3-ITD positive and NPM1mut negative/FLT3-ITD positive (p=0.235; 0.444, respectively), NPM1mut positive/FLT3-ITD negative and NPM1mut negative/FLT3-ITD negative (p=0.376; 0.324, respectively). Conclusions: The FLT3-ITD gene confers a poor prognosis in patients with acute promyelocytic leukemia, but the NPM1mut gene had no effect on efficacy and did no change the prognostic value of FLT3- ITD.