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Prognostic Value of Genetic Alterations in Elderly Patients with Acute Myeloid Leukemia: A Single Institution Experience

1
Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, 69495 Pierre Bénite, France
2
University Claude Bernard Lyon 1, 69100 Villeurbanne, France
3
Department of Hematology, Centre Léon Bérard, 69008 Lyon, France
4
Laboratory of Molecular Biology, Lyon-Sud Hospital, Hospices Civils de Lyon, 69495 Pierre Bénite, France
5
Laboratory of Cytology and Immunology, Lyon-Sud Hospital, Hospices Civils de Lyon, 69495 Pierre Bénite, France
6
Laboratory of Cytogenetics, Lyon-Sud Hospital, Hospices Civils de Lyon, 69495 Pierre Bénite, France
*
Author to whom correspondence should be addressed.
Cancers 2019, 11(4), 570; https://doi.org/10.3390/cancers11040570
Received: 24 February 2019 / Revised: 23 March 2019 / Accepted: 8 April 2019 / Published: 22 April 2019
(This article belongs to the Special Issue Acute Myeloid Leukemia)
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Abstract

Although the outcome in younger adults with acute myeloid leukemia (AML) has improved, the benefit associated with standard intensive chemotherapy in older patients remains debatable. In this study, we investigated the incidence and the prognostic significance of genetic characteristics according to treatment intensity in patients aged 60 years or older. On the 495 patients of our cohort, DNMT3A R882 (25.2%), NPM1 (23.7%) and FLT3-ITD (16.8%) were the most frequent molecular mutations found at diagnosis. In this elderly population, intensive chemotherapy seemed to be a suitable option in terms of early death and survival, except for normal karyotype (NK) NPM1−FLT3-ITD+ patients and those aged over 70 within the adverse cytogenetic/molecular risk group. The FLT3-ITD mutation was systematically associated with an unfavorable outcome, independently of the ratio. NK NPM1+/FLT3-TKD+ genotype tends to confer a good prognosis in patients treated intensively. Regarding minimal residual disease prognostic value, overall survival was significantly better for patients achieving a 4 log NPM1 reduction (median OS: 24.4 vs. 12.8 months, p = 0.013) but did not reach statistical significance for progression free survival. This retrospective study highlights that intensive chemotherapy may not be the most appropriate option for each elderly patient and that molecular markers may help treatment intensity decision-making. View Full-Text
Keywords: acute myeloid leukemia; molecular markers; minimal residual disease; elderly; prognosis acute myeloid leukemia; molecular markers; minimal residual disease; elderly; prognosis
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Heiblig, M.; Labussière-Wallet, H.; Nicolini, F.E.; Michallet, M.; Hayette, S.; Sujobert, P.; Plesa, A.; Balsat, M.; Paubelle, E.; Barraco, F.; Tigaud, I.; Ducastelle, S.; Wattel, E.; Salles, G.; Thomas, X. Prognostic Value of Genetic Alterations in Elderly Patients with Acute Myeloid Leukemia: A Single Institution Experience. Cancers 2019, 11, 570.

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