No evidence that FLT3 status should be considered as an indicator for transplantation in acute myeloid leukemia (AML): an analysis of 1135 patients, excluding acute promyelocytic leukemia, from the UK MRC AML 10 and 12 trials
No evidence that FLT3 status should be considered as an indicator for transplantation in acute myeloid leukemia (AML): an analysis of 1135 patients, excluding acute promyelocytic leukemia, from the UK MRC AML 10 and 12 trials
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DOI：
10.1182/blood-2005-03-1323
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发表时间：
2005-11-15
期刊：
影响因子：
20.3
通讯作者：
Linch, DC
中科院分区：
文献类型：
--
作者：
Gale, RE;Hills, R;Linch, DC
胎儿肝酪氨酸激酶3 （FLT3）内串联重复（ITDs）是急性髓细胞白血病（AML）复发的重要不良预后指标，但FLT3/ ITD+患者最有效的治疗方法目前尚不清楚。我们根据英国医学研究委员会（UK MRC） AML方案治疗的1135名成年患者的FLT3/ITD状态评估结果：首次完全缓解（CR）时，141名接受了自体移植物，170名接受了匹配的同胞同种异体移植物。25%的患者检测到FLT3/ITD，是复发的独立预测因子（P < 0.001）。接受移植的患者复发率增加仍然是预后因素（优势比[OR] = 1.91； 95%可信区间[ci] 1.13-3.21; P = 0.02），没有证据表明接受自体移植的患者（OR = 2.39; ci = 1.24-4.62）和接受同种异体移植的患者（OR = 1.31; ci = 0.56-3.06）（相互作用检验，P = 0.3）或接受或未接受移植的患者（P = 0.4）之间的效果有差异。这些结果在对186名患者的分析中得到证实，这些患者在第一次CR中随机接受或不接受自体移植物，并在683名患者的供体与非供体分析中评估异体移植物的作用（后者，FLT3/ITD- or = 0.70, CIs = 0.53-0.92; FLT3/ITD+ or = 0.59, CIs = 0.40-0.87；相互作用测试，P = 0.5）。这些结果表明，目前没有强有力的证据表明FLT3状态会影响进行移植的决定。
Fetal liver tyrosine kinase 3 (FLT3) internal tandem duplications (ITDs) are powerful adverse prognostic indicators for relapse in acute myelold leukemia (AML) but the most efficacious therapy for FLT3/ ITD+ patients is currently unknown. We evaluated outcome according to FLT3/ITD status in 1135 adult patients treated according to United Kingdom Medical Research Council (UK MRC) AML protocols: 141 received an autograft, and 170 received a matched sibling allograft in first complete remission (CR). An FLT3/ITD was detected in 25% of patients and was an independent predictor for relapse (P < .001). It remained prognostic for increased relapse in patients who received a transplant (odds ratio [OR] = 1.91; 95% confidence intervals [CIs] 1.13-3.21; P = .02), with no evidence of a difference in effect between patients who received an autograft (OR = 2.39; CIs = 1.24-4.62) and patients who received an allograft (OR = 1.31; CIs = 0.56-3.06) (test for interaction, P = .3) or between patients who did or did not receive a transplant (P = .4). These results were confirmed in an analysis of 186 patients randomized to receive or not receive an autograft in first CR and in a donor-versus-no donor analysis of 683 patients to assess the role of allograft (for latter, FLT3/ITD- OR = 0.70, CIs = 0.53-0.92; FLT3/ITD+ OR = 0.59, CIs = 0.40-0.87; test for interaction, P = .5). These results suggest that at present there is no strong evidence that FLT3 status should influence the decision to proceed to transplantation.