The Induction Effect Of Chemotherapy Regimen Containing Homoharringtonine To Acute Myeloid Leukemia With FLT3-ITD Mutation

Aim:To investigate the effect of FLT3-ITD mutation on the normal karyotype acute myeloid leukemia’s clinical manifestation and outcome and to compare the inducing effect of regimen with or without the homoharringtonine.Method:This study retrospectively analysis the patients with acute myeloid leukemia diagnosed in our center from January 2010 to January 2016.Patients who were not tested for FLT3-ITD mutation,who did not accept the induction chemotherapy in our center and who has abnormal karyotype are excluded.The endpoints of the research are the CR rate and the OS.The patients are further assigned into two groups according to whether the induction chemotherapy regimen containing homoharringtonine to discuss the effect of homoharringtonine to FLT3-ITD mutation.Results:This research included 588 normal karyotype AML patients initially who were tested FLT3-ITD mutation,including 350 patients with normal karyotype.There were 46 patients were excluded from the research because of not accepting the induction therapy for early death or other reason.Among the rest 304 patients there were 58 patients carries FLT3-ITD mutation,consists 19.1%.FLT3-ITD mutated patients has significant higher peripheral leukocytes count and bone marrow blast countes.The initial mean peripheral leukocytes counts of the patients with FLT3-ITD mutation is 76.21±8.8×109/L,and it is 37.2±3.5×109/L in the wild type group,p<0.001.The initial mean bone marrow blast ratio of the patients with FLT3-ITD mutation is 72.9±2.36%,and it is 38.5±6.5×109/L in the wild type group,p<0.001.27 patients were FLT3-ITD mutation positive in the 80 NPM1 mutated patients,while 31 patients were FLT3-ITD mutation positive in 224 NPM1 mutation negative patients,p<0.001.Among the 58 patients with FLT3-ITD mutation,18 patients were inducted with regimen containing homoharringtonine.The median follow up is 17.7 months.The first-regimen CR rate in the homoharringtonine is 26.3%and it is 40%in the non-homoharringtonine group,with no statistic significance.After the first two regimens,the CR rate is 60.3%in the FLT3-ITD mutated group on average and it is 62.5%and 55.6%in non-homoharringtonine group and homoharringtonine respectively and there is no statistical difference.Conclusion:FLT3-ITD mutation is an independent risk of AML.In this research we find that in the normal karyotype AML the FLT3-ITD mutations occur in 18.9%of the patients.These patients are more likely to have a higher peripheral blood leukocytes count and a higher bone marrow blastic cell count.The NPM1 mutations are common to occur in combination with FLT3-ITD mutation.Patients with FLT3-ITD mutation have a lower CR rate and a short overall survival,which can not be reverted by NPM1 mutations.Induction regimen containing homoharringtonine also shows no effect on the CR rate and OS of these patients.