The Outcome of Allogeneic Hematopoietic Cell Transplantation for Children with FMS-Like Tyrosine Kinase 3 Internal Tandem Duplication–Positive Acute Myelogenous Leukemia

• Report on 29 children who underwent allogeneic HSCT for FLT3/ITD positive acute myelogenous leukemia (AML).
• No patients experienced transplant related mortality (TRM). Eleven patients (38%) experienced relapsed disease. The cumulative incidence of relapse at 2 years was 34.7% (95% CI 20.4–54.9%).
• 2-years DFS and OS were 65.3% (95% CI 45.1–79.6%) and 82.2% (95% CI 58.5–91.3%), respectively.
• Patients with higher FLT3/ITD ratio at diagnosis had significantly worse DFS (HR 1.42 (1.04–1.93), p=0.03).
• The use of TBI in the preparative regimen was associated with superior DFS and OS (HR 0.29 (0.08–0.99), p =0.04) (HR 0.07 (0.01–0.62), p= 0.002), respectively

FMS-like tyrosine kinase 3 (FLT3) internal tandem duplication (ITD) is a somatic mutation associated with poor outcome when treated with chemotherapy alone. In children, hematopoietic stem cell transplantation (HSCT) is recommended, but very limited data on outcome are reported. We determined the outcome of 29 children with FLT3/ITD–positive acute myelogenous leukemia (AML) who underwent allogeneic HSCT in 4 pediatric centers. Eleven patients (38%) received matched related donor hematopoietic stem cells and 18 (62%) received alternative donors. Eighteen patients (62%) received total body irradiation (TBI)–based regimens. No patients experienced transplantation-related mortality. Eleven patients (38%) experienced relapsed disease. The cumulative incidence of relapse at 2 years was 34.7% (95% confidence interval [CI], 20.4% to 54.9%). Two-year disease-free survival (DFS) and overall survival (OS) were 65.3% (95% CI, 45.1% to 79.6%) and 82.2% (95% CI, 58.5% to 91.3%), respectively. There was no difference in the DFS of patients who received transplants from related donors versus the DFS of those who received transplants from alternative donors (hazard ratio [HR], 2.64; 95% CI, .79 to 8.76; P = .10), using univariate analysis. Patients with higher FLT3/ITD ratio at diagnosis had significantly worse DFS (HR, 1.42; 95% CI, 1.04 to 1.93; P = .03). The use of TBI in the preparative regimen was associated with superior DFS (HR, .29; 95% CI, .08 to .99; P = .04) and OS (HR, .07; 95% CI, .01 to .62; P = .002). We conclude that allogeneic HSCT improves DFS and OS in children with FLT3/ITD–positive AML compared with what has been reported in those treated with chemotherapy alone.