Erschienen in:
01.08.2014 | Review Article
Prognostic significance of FLT3 internal tandem duplication, nucleophosmin 1, and CEBPA gene mutations for acute myeloid leukemia patients with normal karyotype and younger than 60 years: a systematic review and meta-analysis
verfasst von:
M. Port, M. Böttcher, F. Thol, A. Ganser, R. Schlenk, J. Wasem, A. Neumann, L. Pouryamout
Erschienen in:
Annals of Hematology
|
Ausgabe 8/2014
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Abstract
Diagnosis and classification of acute myeloid leukemia (AML) are based on morphology and genetics. An increasing number of gene mutations have been found, and some are used for risk classification in AML patients with normal karyotype (cytogenetically normal (CN)-AML). In this systematic review and meta-analysis, we examined three frequent mutations in CN-AML: mutations of
fms-related tyrosine kinase 3 (
FLT3-ITD), mutated nucleophosmin (
NPM1), and mutations of the CCAAT enhancer-binding protein alpha (
CEBPA) gene. A systematic literature search of publications listed in the electronic databases (Embase, Pubmed, Healthstar, BIOSIS, ISI Web of Knowledge and Cochrane) from 2000 up to March 2012 was performed (Fig.
1). Nineteen studies were included and qualitatively analyzed. Two to four studies entered the quantitative meta-analysis incorporating 1,378 to 1,942 patients with CN-AML. Meta-analysis for overall survival (OS) and relapse-free survival (RFS) showed
FLT3-ITD to predict an unfavorable prognosis, with hazard ratios (HR) of 1.86 and 1.75, respectively. In contrast, meta-analysis of the impact of
NPM1 and
CEBPA mutations on OS yielded an HR of 0.56 for each mutation, while analysis of impact on RFS produced HRs of 0.37 and 0.42, respectively. This systematic review and meta-analysis aimed to evaluate the prognostic value of mutations in the
NPM1,
CEBPA, and
FLT3 genes.
FLT3-ITD was associated with worse prognosis, whereas mutations in
NPM1 and
CEBPA genes were associated with a favorable prognosis.