Improved FLT3 Internal Tandem Duplication PCR Assay Predicts Outcome after Allogeneic Transplant for Acute Myeloid Leukemia

Michael R. Grunwald, Li Hui Tseng, Ming-Tseh Lin, Keith Pratz, James Eshleman, Mark J Levis, Christopher Gocke

Research output: Contribution to journalArticle

Abstract

Patients with acute myeloid leukemia (AML) who harbor internal tandem duplication (ITD) mutations of the FMS-like tyrosine kinase 3 (. FLT3) gene carry a poor prognosis. Although allogeneic transplantation may improve outcomes, relapse occurs frequently. The FLT3/ITD mutation has been deemed an unsuitable minimal residual disease (MRD) marker because it is unstable and because the standard assay for the mutation is relatively insensitive. The FLT3 mutation is undetectable by PCR at pre- or post-transplant time points in many FLT3/ITD AML patients who subsequently relapse after transplant. We report the application of a new technique, tandem duplication PCR (TD-PCR), for detecting MRD in FLT3/ITD AML patients. Between October 2004 and January 2012, 54 FLT3/ITD AML patients in remission underwent transplantation at our institution. Of 37 patients with available day 60 marrow samples, 28 (76%) were assessable for MRD detection. In seven of 28 patients (25%), the FLT3/ITD mutation was detectable by TD-PCR but not by standard PCR on day 60. Six of 7 patients (86%) with MRD by TD-PCR have relapsed to date compared with only 2 of 21 patients (10%) who were negative for MRD (. P=.0003). The ability to detect MRD by this sensitive technique may provide an opportunity for early clinical intervention.

Original languageEnglish (US)
Pages (from-to)1989-1995
Number of pages7
JournalBiology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
Volume20
Issue number12
DOIs
StatePublished - Dec 1 2014

Fingerprint

Acute Myeloid Leukemia
Residual Neoplasm
Transplants
Polymerase Chain Reaction
Mutation
Recurrence
Homologous Transplantation
Protein-Tyrosine Kinases
Transplantation
Bone Marrow
Genes

Keywords

  • Acute myeloid leukemia (AML)
  • Bone marrow transplant
  • FLT3
  • Internal tandem duplication(ITD)
  • Minimal residual disease(MRD)
  • Tandem duplication PCR(TD-PCR)

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

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title = "Improved FLT3 Internal Tandem Duplication PCR Assay Predicts Outcome after Allogeneic Transplant for Acute Myeloid Leukemia",
abstract = "Patients with acute myeloid leukemia (AML) who harbor internal tandem duplication (ITD) mutations of the FMS-like tyrosine kinase 3 (. FLT3) gene carry a poor prognosis. Although allogeneic transplantation may improve outcomes, relapse occurs frequently. The FLT3/ITD mutation has been deemed an unsuitable minimal residual disease (MRD) marker because it is unstable and because the standard assay for the mutation is relatively insensitive. The FLT3 mutation is undetectable by PCR at pre- or post-transplant time points in many FLT3/ITD AML patients who subsequently relapse after transplant. We report the application of a new technique, tandem duplication PCR (TD-PCR), for detecting MRD in FLT3/ITD AML patients. Between October 2004 and January 2012, 54 FLT3/ITD AML patients in remission underwent transplantation at our institution. Of 37 patients with available day 60 marrow samples, 28 (76{\%}) were assessable for MRD detection. In seven of 28 patients (25{\%}), the FLT3/ITD mutation was detectable by TD-PCR but not by standard PCR on day 60. Six of 7 patients (86{\%}) with MRD by TD-PCR have relapsed to date compared with only 2 of 21 patients (10{\%}) who were negative for MRD (. P=.0003). The ability to detect MRD by this sensitive technique may provide an opportunity for early clinical intervention.",
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AU - Grunwald, Michael R.

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AU - Pratz, Keith

AU - Eshleman, James

AU - Levis, Mark J

AU - Gocke, Christopher

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AB - Patients with acute myeloid leukemia (AML) who harbor internal tandem duplication (ITD) mutations of the FMS-like tyrosine kinase 3 (. FLT3) gene carry a poor prognosis. Although allogeneic transplantation may improve outcomes, relapse occurs frequently. The FLT3/ITD mutation has been deemed an unsuitable minimal residual disease (MRD) marker because it is unstable and because the standard assay for the mutation is relatively insensitive. The FLT3 mutation is undetectable by PCR at pre- or post-transplant time points in many FLT3/ITD AML patients who subsequently relapse after transplant. We report the application of a new technique, tandem duplication PCR (TD-PCR), for detecting MRD in FLT3/ITD AML patients. Between October 2004 and January 2012, 54 FLT3/ITD AML patients in remission underwent transplantation at our institution. Of 37 patients with available day 60 marrow samples, 28 (76%) were assessable for MRD detection. In seven of 28 patients (25%), the FLT3/ITD mutation was detectable by TD-PCR but not by standard PCR on day 60. Six of 7 patients (86%) with MRD by TD-PCR have relapsed to date compared with only 2 of 21 patients (10%) who were negative for MRD (. P=.0003). The ability to detect MRD by this sensitive technique may provide an opportunity for early clinical intervention.

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