Prognostic impact of DNMT3A mutations in patients with intermediate cytogenetic risk profile acute myeloid leukemia.
Summary of "Prognostic impact of DNMT3A mutations in patients with intermediate cytogenetic risk profile acute myeloid leukemia."
Objectives:  Recently, mutations in DNMT3A gene have been described in about 25% acute myeloid leukemia (AML) cases, preferentially in monocytic AML. They were found to predict worse overall survival (OS) of mutated patients. Patients and methods:  RT-PCR followed by direct sequencing was used to test the presence of DNMT3A mutations in 226 AML patients with an intermediate-risk (IR) cytogenetics. Results:  67 patients out of 226 (29.6%) carried a mutation in the DNMT3A gene. Occurrence of DNMT3A mutations was associated with female sex (P=0.027) and with the presence of FLT3/ITD (P=0.003) but not with particular FAB subtypes. Patients with DNMT3A mutation had higher initial WBC counts than those without it (P=0.064) only due to higher incidence of FLT3/ITD within these cases. There was no difference between mutated and wild-type groups in reaching complete remission (CR) (P=0.380). OS was not affected by DNMT3A mutation (P=0.251), but OS of patients who reached CR was longer in DNMT3A negative cases (P=0.025). Patients with DNMT3A mutation had a higher relapse rate (P=0.007). Patients carrying both the DNMT3A mutation and FLT3/ITD relapsed more often than either patients with single DNMT3A mutation (P=0.044) or patients with FLT3/ITD only (P=0.058). DNMT3A mutations were associated with higher relapse rate even within the FLT3/ITD negative group (P=0.072). After reaching CR, these two genetic factors were independent predictors of relapse at multivariate analysis (P<0.001). Only 3 of 30 "double mutated" (FLT3/ITD+, DNMT3A+) patients are still alive, all of them having undergone hematopoietic stem cell transplant. Conclusions:  We have confirmed the high incidence of DNMT3A mutations in patients with AML with IR cytogenetics. Patients with DNMT3A mutations relapse more often and have inferior OS when only patients achieving CR are analyzed. "Double mutated" patients have a very poor prognosis.
Affiliation
Institute of Hematology and Blood Transfusion, Prague 2, Czech Republic Institute of Physiology, 1st Faculty of Medicine, Charles University, Prague 2, Czech Republic.
Journal Details
This article was published in the following journal.
Name: European journal of haematology
ISSN: 1600-0609
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21967546
- DOI: http://dx.doi.org/10.1111/j.1600-0609.2011.01716.x
Medical and Biotech [MESH] Definitions
Molecular Diagnostic Techniques
MOLECULAR BIOLOGY techniques used in the diagnosis of disease. Included are such techniques as IN SITU HYBRIDIZATION of chromosomes for CYTOGENETIC ANALYSIS; OLIGONUCLEOTIDE ARRAY SEQUENCE ANALYSIS of gene expression patterns in disease states; identification of pathogenic organisms by analysis of species specific DNA sequences; and detection of mutations with POLYMERASE CHAIN REACTION.
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Neurofilament Proteins
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Metacercariae
Encysted cercaria which house the intermediate stages of trematode parasites in tissues of an intermediate host.
Preimplantation Diagnosis
Determination of the nature of a pathological condition or disease in the ovum, zygote, or blastocyst prior to implantation. CYTOGENETIC ANALYSIS is performed to determine the presence or absence of genetic disease.
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