Stem cell transplantation in adults with acute myelogenous leukemia, normal cytogenetics, and the FLT3-ITD mutation

• Patients with FLT3 + AML have poor prognosis with chemotherapy alone.
• We reviewed a single center experience with SCT in FLT3 + patients.
• Stem cell transplant can abrogate the poor prognosis in FLT3 + AML patients.

Following chemotherapy, patients with acute myelogenous leukemia (AML), normal cytogenetics, and the FLT3-ITD mutation have shorter survival compared to wild type (WT) patients. To determine the role of stem cell transplantation (SCT), we performed a retrospective review of adult patients with AML who underwent SCT at our center between January 1, 2007 and December 31, 2011. Of the 200 patients transplanted, 79 patients (40%) had normal cytogenetics; of these, 17 (22%) had the FLT3-ITD mutation, 35 were WT (44%), and 27 (34%) did not have FLT3 testing performed. Clinical characteristics were similar in each group. At four years, overall survival (OS) between FLT3 positive and WT groups was similar: 0.54 (95% CI 0.29–0.75) versus 0.73 (95% CI 0.53–0.99), p = 0.18. Relapse rates were also similar, 0.09 (95% CI 0.02–0.21) versus 0.12 (95% CI: 0.02–0.32); p = 0.67. We conclude that SCT can abrogate the poor prognosis in FLT3-ITD positive patients.