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Br J Haematol. 2019 Apr 9. doi: 10.1111/bjh.15916. [Epub ahead of print]

Prognostic significance of mutation profile at diagnosis and mutation persistence during disease remission in adult acute myeloid leukaemia patients.

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Department of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic.
Department of Internal Medicine - Hematology and Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic.
Institute of Hematology and Blood Transfusion, Prague, Czech Republic.
Department of Hematology and Oncology, University Hospital Pilsen, Pilsen, Czech Republic.
Department of Hemato-Oncology, University Hospital Olomouc, Olomouc, Czech Republic.
Department of Internal Medicine - Department of Hematology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.


In this multi-centre study, we analysed the prognostic impact of mutations in 19 genes associated with myeloid malignancies in 258 newly diagnosed acute myeloid leukaemia patients (aged 19-70 years) undergoing intensive therapy. We identified five patient groups with different prognostic risks and different benefits from allogeneic hematopoietic stem cell transplantation (alloHSCT) within the intermediate cytogenetic risk group patients (n = 184). The most adverse prognosis was observed in patients with DNMT3A and FLT3-ITD co-mutation, whose survival could be significantly improved with alloHSCT. In contrast, the most favourable prognosis without any further benefit from alloHSCT was identified in patients with mutations in NPM1 or CEBPA, after exclusion of the unfavourable prognostic groups defined by mutations in DNMT3A, RUNX1 or genes from chromatin/spliceosome group. An additional analysis of 113 diagnosis-remission paired samples revealed that persistence of non-DNMT3A mutations (above 2% VAF) represented a further negative prognostic factor. The proposed model offers a possible molecular stratification and treatment guidance for intermediate cytogenetic risk group patients.


acute myeloid leukaemia; next generation sequencing; persistent mutations; prognostic markers; survival


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