Blood Res  
Favorable long-term survival using consolidation chemotherapy without allogeneic hematopoietic cell transplantation for acute myeloid leukemia with wild-type NPM1 without FLT3-ITD
Dong Won Baek1*, Jung Min Lee1*, Ju-Hyung Kim1, Hee Jeong Cho1, Ji-Yeon Ham2, Jang-Soo Suh2, Sang-Kyun Sohn1, Joon Ho Moon1
1Department of Hematology/Oncology, 2Department of Laboratory Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
Correspondence to: Joon Ho Moon, M.D., Ph.D.
Department of Hematology/Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea
E-mail: jhmoon@knu.ac.kr
*Authors contributed equally to this work.
Published online: August 23, 2019.
© The Korean Journal of Hematology. All rights reserved.

Abstract
Background
The role of allogeneic hematopoietic cell transplantation (allo-HCT) compared with consolidation chemotherapy alone in intermediate-risk acute myeloid leukemia (AML) patients with wild-type nucleophosmin/negative or a low level of Fms related tyrosine kinase 3 internal tandem duplication (NPM1wt/FLT3-ITDneg/low) has not yet been elucidated.
Methods
In this study, we retrospectively investigated 88 patients newly diagnosed with AML who received intensive induction chemotherapy at Kyungpook National University Hospital from March 2015 to July 2017. The selection criteria included the presence of results on genetic abnormalities including NPM1 and FLT3-ITD.
Results
According to the European LeukemiaNet (ELN) risk classification, 25 patients (28%) were categorized as favorable, 44 (50%) as intermediate, and 19 (22%) as adverse risk. Among the intermediate-risk patients, 40 were identified as NPM1wt/FLT3-ITDneg/low. Among the patients with NPM1wt/FLT3-ITDneg/low, complete remission (CR) was achieved in 26 patients out of 40 (65%). One-year overall survival (OS) rate was 100% in the favorable-risk group and 87.9% in the NPM1wt/FLT3-ITDneg/low group (P=0.233). Among the intermediaterisk NPM1wt/FLT3-ITDneg/low patients, there was no survival benefit with allo-HCT (N=19) compared to consolidation chemotherapy (N=21; P=0.372). In the multivariate analysis, the ELN risk group [hazard ratio (HR), 6.36; P=0.019] and the achievement of CR (HR, 2.95; P=0.017) were both identified as factors affecting OS of patients with newly diagnosed AML.
Conclusion
Among the AML patients, intermediate-risk NPM1wt/FLT3-ITDneg/low patients and favorable-risk patients showed similar OS rates. Our results suggested that allo-HCT might have limited clinical benefit for the intermediate-risk NPM1wt/FLT3-ITDneg/low patients. Well controlled studies are needed to confirm the current results.
Keywords: Acute myeloid leukemia, Allogeneic hematopoietic cell transplantation, NPM1, FLT3-ITD


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