期刊
CURRENT OPINION IN ONCOLOGY
卷 25, 期 2, 页码 195-204出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CCO.0b013e32835ec91f
关键词
acute myeloid leukemia; cell; FLT3/ITD; hematopoietic; transplantation
类别
资金
- Fondo de Investigaciones Sanitarias (FIS) [EC11-364 P, I01100872]
- Red Tematica de Investigacion Cooperativa en Cancer, Instituto de Salud Carlos III, Madrid [RD06/0020/0101]
- Fundacio La Marato de TV3 [100830/31/32]
- Ajuts de suport als Grups de Recerca de Catalunya (SGR) [2009-SGR-1246]
- Fundacion CELLEX, Barcelona, Spain
Purpose of review Patients with acute myeloid leukemia (AML) traditionally classified as having an intermediate cytogenetic risk [mostly cytogenetically normal AML (CN-AML)] really include a significant proportion of cases with a poor outcome. This is based on the molecular findings at diagnosis, mainly the presence of internal tandem duplication in the FMS-like tyrosine kinase 3 gene(s)(FLT3/ITD). Optimal postremission therapy for these high-risk molecular cases is not well established; as the prognosis is adverse hematopoietic cell transplantation (HCT), mainly allogeneic HCT (allo-HCT), is the most widely accepted strategy. Recent findings As a rule, patients with FLT3/ITD have a poor outcome with conventional chemotherapy alone. Only patients with an associated nucleophosmin 1 (NPM1) mutation and those with a low mutated-to-wild-type allelic ratio of FLT3/ITD have less unfavorable outcome. Most studies show an advantage of allo-HCT in first complete remission (CR1), with higher 3-5 year disease-free survival and lower relapse risk than with chemotherapy or autologous transplantation (auto-HCT). Regarding allo-HCT proceeding early after reaching CR1 seems to improve survival, rather than after several courses of consolidation chemotherapy. Summary Patients with intermediate-risk cytogenetics AML and FLT3/ITD, especially NPM1-wild cases and those NPM1 mutated with a high allelic ratio, should proceed to allo-HCT if possible early after achieving CR1.
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