Prognostic impact of FLT3-ITD microclones in young adults with acute myeloid leukemia treated with intensive chemotherapy - PubMed
3 hours ago
- #FLT3-ITD microclones
- #relapse risk
- #acute myeloid leukemia
- FLT3-ITD microclones (allelic ratio 0.0004-0.05) were detected in 17.4% of young AML patients without macroclones in the BIG-1 trial.
- Both microclones and macroclones independently increased relapse risk, with cumulative incidence at 2 years: 45.1% for microclones, 42.5% for macroclones, vs. 29.4% for no FLT3-ITD.
- In NPM1-mutated AML, microclones and macroclones linked to higher measurable residual disease (MRD) and relapse risk, though no independent impact on overall survival after MRD adjustment.
- 41.8% of relapses in patients with microclones at diagnosis involved a macroclone at relapse, highlighting clonal evolution.
- Findings challenge current risk stratification and support integrating NGS-based FLT3-ITD detection into AML diagnostic and prognostic workflows, with need for prospective trials and ELN guideline updates.