Relapse risk and survival in patients with FLT3 mutated acute myeloid leukemia undergoing stem cell transplantation

Sameh Gaballa, Rima Saliba, Betul Oran, Jonathan E. Brammer, Julianne Chen, Gabriela Rondon, Amin M. Alousi, Partow Kebriaei, David Marin, Uday R. Popat, Borje S. Andersson, Elizabeth J. Shpall, Elias Jabbour, Naval Daver, Michael Andreeff, Farhad Ravandi, Jorge Cortes, Keyur Patel, Richard E. Champlin, Stefan O. Ciurea

Research output: Contribution to journalArticle

Abstract

In patients with AML with FMS-like tyrosine kinase 3 (FLT3) mutations, the significance of minimal residual disease (MRD) detected by PCR before allogeneic stem cell transplantation (SCT) on outcomes after transplant remains unclear. We identified 200 patients with FLT3-AML who underwent SCT at our institution. Disease status at transplant was: first or second complete remission (CR1/CR2, n = 119), high-risk CR (third or subsequent CR, marrow hypoplasia, or incomplete count recovery) (CR-HR, n = 31), and morphological evidence of active disease (AD, n = 50). The median follow-up was 27 months, and the 2-year overall and progression-free survival were 43% and 41%, respectively. Relapse was highest in the AD group (85%) and the CR-HR FLT3 MRD positive group (72%), followed by CR-HR FLT3 MRD negative (58%), CR1/CR2 FLT3 MRD positive (39%), and lowest in the CR1/CR2 FLT3 MRD negative group (23%). On multivariate analysis, independent factors influencing the risk of relapse were detectable morphological disease and FLT3 MRD by PCR pre-transplant. Factors that did not influence the relapse risk included: age, graft type, graft source, type of FLT3 mutation, or conditioning intensity. Morphologic and molecular remission status at the time of transplant were key predictors of disease relapse and survival in patients with FLT3-AML.

Original languageEnglish (US)
Pages (from-to)331-337
Number of pages7
JournalAmerican Journal of Hematology
Volume92
Issue number4
DOIs
StatePublished - Apr 1 2017
Externally publishedYes

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Stem Cell Transplantation
Acute Myeloid Leukemia
Protein-Tyrosine Kinases
Residual Neoplasm
Recurrence
Survival
Transplants
Polymerase Chain Reaction
Mutation
Disease-Free Survival
Multivariate Analysis
Bone Marrow

ASJC Scopus subject areas

  • Hematology

Cite this

Gaballa, S., Saliba, R., Oran, B., Brammer, J. E., Chen, J., Rondon, G., ... Ciurea, S. O. (2017). Relapse risk and survival in patients with FLT3 mutated acute myeloid leukemia undergoing stem cell transplantation. American Journal of Hematology, 92(4), 331-337. https://doi.org/10.1002/ajh.24632

Relapse risk and survival in patients with FLT3 mutated acute myeloid leukemia undergoing stem cell transplantation. / Gaballa, Sameh; Saliba, Rima; Oran, Betul; Brammer, Jonathan E.; Chen, Julianne; Rondon, Gabriela; Alousi, Amin M.; Kebriaei, Partow; Marin, David; Popat, Uday R.; Andersson, Borje S.; Shpall, Elizabeth J.; Jabbour, Elias; Daver, Naval; Andreeff, Michael; Ravandi, Farhad; Cortes, Jorge; Patel, Keyur; Champlin, Richard E.; Ciurea, Stefan O.

In: American Journal of Hematology, Vol. 92, No. 4, 01.04.2017, p. 331-337.

Research output: Contribution to journalArticle

Gaballa, S, Saliba, R, Oran, B, Brammer, JE, Chen, J, Rondon, G, Alousi, AM, Kebriaei, P, Marin, D, Popat, UR, Andersson, BS, Shpall, EJ, Jabbour, E, Daver, N, Andreeff, M, Ravandi, F, Cortes, J, Patel, K, Champlin, RE & Ciurea, SO 2017, 'Relapse risk and survival in patients with FLT3 mutated acute myeloid leukemia undergoing stem cell transplantation', American Journal of Hematology, vol. 92, no. 4, pp. 331-337. https://doi.org/10.1002/ajh.24632
Gaballa, Sameh ; Saliba, Rima ; Oran, Betul ; Brammer, Jonathan E. ; Chen, Julianne ; Rondon, Gabriela ; Alousi, Amin M. ; Kebriaei, Partow ; Marin, David ; Popat, Uday R. ; Andersson, Borje S. ; Shpall, Elizabeth J. ; Jabbour, Elias ; Daver, Naval ; Andreeff, Michael ; Ravandi, Farhad ; Cortes, Jorge ; Patel, Keyur ; Champlin, Richard E. ; Ciurea, Stefan O. / Relapse risk and survival in patients with FLT3 mutated acute myeloid leukemia undergoing stem cell transplantation. In: American Journal of Hematology. 2017 ; Vol. 92, No. 4. pp. 331-337.
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abstract = "In patients with AML with FMS-like tyrosine kinase 3 (FLT3) mutations, the significance of minimal residual disease (MRD) detected by PCR before allogeneic stem cell transplantation (SCT) on outcomes after transplant remains unclear. We identified 200 patients with FLT3-AML who underwent SCT at our institution. Disease status at transplant was: first or second complete remission (CR1/CR2, n = 119), high-risk CR (third or subsequent CR, marrow hypoplasia, or incomplete count recovery) (CR-HR, n = 31), and morphological evidence of active disease (AD, n = 50). The median follow-up was 27 months, and the 2-year overall and progression-free survival were 43{\%} and 41{\%}, respectively. Relapse was highest in the AD group (85{\%}) and the CR-HR FLT3 MRD positive group (72{\%}), followed by CR-HR FLT3 MRD negative (58{\%}), CR1/CR2 FLT3 MRD positive (39{\%}), and lowest in the CR1/CR2 FLT3 MRD negative group (23{\%}). On multivariate analysis, independent factors influencing the risk of relapse were detectable morphological disease and FLT3 MRD by PCR pre-transplant. Factors that did not influence the relapse risk included: age, graft type, graft source, type of FLT3 mutation, or conditioning intensity. Morphologic and molecular remission status at the time of transplant were key predictors of disease relapse and survival in patients with FLT3-AML.",
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AU - Gaballa, Sameh

AU - Saliba, Rima

AU - Oran, Betul

AU - Brammer, Jonathan E.

AU - Chen, Julianne

AU - Rondon, Gabriela

AU - Alousi, Amin M.

AU - Kebriaei, Partow

AU - Marin, David

AU - Popat, Uday R.

AU - Andersson, Borje S.

AU - Shpall, Elizabeth J.

AU - Jabbour, Elias

AU - Daver, Naval

AU - Andreeff, Michael

AU - Ravandi, Farhad

AU - Cortes, Jorge

AU - Patel, Keyur

AU - Champlin, Richard E.

AU - Ciurea, Stefan O.

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N2 - In patients with AML with FMS-like tyrosine kinase 3 (FLT3) mutations, the significance of minimal residual disease (MRD) detected by PCR before allogeneic stem cell transplantation (SCT) on outcomes after transplant remains unclear. We identified 200 patients with FLT3-AML who underwent SCT at our institution. Disease status at transplant was: first or second complete remission (CR1/CR2, n = 119), high-risk CR (third or subsequent CR, marrow hypoplasia, or incomplete count recovery) (CR-HR, n = 31), and morphological evidence of active disease (AD, n = 50). The median follow-up was 27 months, and the 2-year overall and progression-free survival were 43% and 41%, respectively. Relapse was highest in the AD group (85%) and the CR-HR FLT3 MRD positive group (72%), followed by CR-HR FLT3 MRD negative (58%), CR1/CR2 FLT3 MRD positive (39%), and lowest in the CR1/CR2 FLT3 MRD negative group (23%). On multivariate analysis, independent factors influencing the risk of relapse were detectable morphological disease and FLT3 MRD by PCR pre-transplant. Factors that did not influence the relapse risk included: age, graft type, graft source, type of FLT3 mutation, or conditioning intensity. Morphologic and molecular remission status at the time of transplant were key predictors of disease relapse and survival in patients with FLT3-AML.

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