Modification of the flt3 mutational status between diagnosis and relapsed/refractory aml: a meta-analysis.

Acute myeloid leukemia (AML) is a hematologic cancer with a high mortality and the FLT3 mutations are recognized as one of the most important alteration associated with AML and are related with a poor prognosis. Some studies have revealed that at diagnosis, patients with AML with FLT3 can maintain the alteration in the relapse or refractory disease, although this is not always the rule. This report is a meta-analysis review about the genetic change of FLT3 mutation in the relapsed/refractory AML scenario and if this what differs from findings at diagnosis in the same patients. A search in June/2020 was performed in PUBMED to identify studies with the terms FLT3 (title/abstract) AND “Acute Myeloid Leukemia” without a restrict date. Six articles described mutation status in both FLT3 alterations. The total of 272 patients with relapse and refractory AML were analyzed, 74 (27%) were positive for FLT3-ITD at diagnosis and 15 (5%) for FLT3-TKD. The change in mutation status occurred in 17% of patients. Mutation status change from negative to FLT3-ITD occurred in 7% of patients, FLT3-ITD to negative in 5%. From those that were FLT3-ITD positive 60 remained positive in the relapse. Our data demonstrated that 41% of patients were positive for FLT3 mutation in some point of the disease. Since one in six patients had their mutational status change in the study, reassessment should be mandatory in any case of relapse and refractoriness. If this is related with worst prognostic more studies are needed to elucidate.