FLT3-ITD MRD “Is a Strong Independent Prognostic Factor for Relapse and Death” in AML

News
Article

Eleanor Mayfield, ELS, discusses FLT3-ITD minimal residual disease in acute myeloid leukemia.

In patients who had achieved complete remission (CR) after two cycles of induction chemotherapy for newly diagnosed acute myeloid leukemia (AML), measurable residual disease (MRD) in internal tandem duplications (ITD) in the FMS-like tyrosine kinase 3 (FLT3) receptor gene was “a strong independent prognostic factor [for] profound risk of relapse and death,” researchers in the Netherlands reported in the Journal of Clinical Oncology in October.

“Furthermore, FLT3-ITD MRD outcompetes the impact of other currently established prognostic factors in FLT3-ITD AML, including the NPM1 mutation status and FLT3-ITD allelic ratio at diagnosis and residual disease measurements in CR” by next-generation sequencing (NGS)–based mutant NPM1 detection or multiparameter flow cytometry, write Peter J.M. Valk, PhD, of the Erasmus MC Cancer Institute at University Medical Center Rotterdam, and colleagues.

FLT3-ITD status was assessed by NGS at AML diagnosis in treatment-naïve patients (median age 51, 51% male) enrolled in clinical trials conducted by the Dutch-Belgian Cooperative

Trial Group for Hematology-Oncology or the Swiss Group for Clinical Cancer Research.

Patients were excluded if NGS did not confirm the presence of FLT3-ITD or if the FLT3-ITD was located in exon 15. Of 161 patients with de novo FLT3-ITD AML included in the analysis, MRD was present after induction in 47 (29%). The presence of FLT3-ITD MRD was associated with a 4-year cumulative incidence of relapse of 75% and 4-year overall survival of 31% versus 33% and 57%, respectively, for those without FLT3-ITD MRD.

The authors note that FLT3-ITD MRD was measured at a single time point, that only patients treated with intensive chemotherapy were studied, and that FLT3-ITD MRD failed to identify all relapses. Despite these limitations, they conclude that “NGS-based detection of FLT3-ITD MRD in CR… furnishes support for FLT3-ITD as a clinically relevant biomarker for dynamic disease risk assessment in AML.”

Reference

Grob T, Sanders MA, Vonk CM, et al. Prognostic Value of FLT3-Internal Tandem Duplication Residual Disease in Acute Myeloid Leukemia [published online ahead of print, 2022 Oct 31]. J Clin Oncol. 2022;JCO2200715. doi:10.1200/JCO.22.00715

Recent Videos
Daniel Peters, MD, aims to reduce the toxicity associated with AML treatments while also improving therapeutic outcomes.
Patients with AML will experience different toxicities based on the treatment they receive, whether it is intensive chemotherapy or targeted therapy.
A younger patient with AML who is more fit may be eligible for different treatments than an older patient with chronic medical conditions.
Yale’s COPPER Center aims to address disparities and out-of-pocket costs for patients, thereby improving the delivery of complex cancer treatment.
Non-Hodgkin lymphoma and other indolent forms of disease may require sequencing new treatments for years or decades, said Scott Huntington, MD, MPH, MSc.
Fixed-duration therapy may be more suitable for younger patients, while continuous therapy may benefit those who are older with more comorbidities.
Determining the molecular characteristics of one’s disease may influence the therapy employed in the first line as well as subsequent settings.
A 2-way communication between providers and patients may help facilitate dose modifications to help better manage adverse effects.
Treatment with AML depends on a variety of factors, including stage of treatment, transplant eligibility, and mutational status.
Related Content
Updated results at ASH 2025 may support new alternatives to continuous therapy and standard intensive chemotherapy across different leukemia types.

ASH 2025: Key Anticipated Updates in the Leukemia Landscape

Russ Conroy
December 4th 2025
Article

Updated results at ASH 2025 may support new alternatives to continuous therapy and standard intensive chemotherapy across different leukemia types.

Experts from Georgia Cancer Center highlight ongoing retrospective studies, translational research, and other initiatives across different cancers.

Evolutions Across NSCLC, Multiple Myeloma, and AML at Georgia Cancer Center

Girindra Raval, MD;Amany Keruakous, MD;Daniel Peters, MD
December 1st 2025
Podcast

Experts from Georgia Cancer Center highlight ongoing retrospective studies, translational research, and other initiatives across different cancers.

According to Daniel Peters, MD, the recent FDA approvals of revumenib and ziftomenib in AML are some of the most exciting developments in the field.

The Paradigm of AML Care: What’s New and What’s Changing

Tim Cortese
November 30th 2025
Article

According to Daniel Peters, MD, the recent FDA approvals of revumenib and ziftomenib in AML are some of the most exciting developments in the field.

Jorge Cortes, MD, outlines the impact of imatinib in chronic myeloid leukemia and highlights future initiatives in the field.

Charting the Evolution of TKIs and Finding the Next Breakthrough in CML

Jorge E. Cortes, MD
October 13th 2025
Podcast

Jorge Cortes, MD, outlines the impact of imatinib in chronic myeloid leukemia and highlights future initiatives in the field.

Tandem CAR T cells targeting mesothelin and MUC16 overcome tumor heterogeneity by targeting one antigen at a time

Tandem CAR T cells targeting mesothelin and MUC16 overcome tumor heterogeneity by targeting one antigen at a time

American Society for Transplantation and Cellular Therapy
November 24th 2025
Article

Researchers have demonstrated that a tandem CAR T cell targeting mesothelin and MUC16 ectodomain is able to outmaneuver tumor heterogeneity, outperforming single target CAR T cells in mixed ovarian and pancreatic models.

Among all patients with AML enrolled in the trial who received olutasidenib, the CR or CRh rate was 35%, with 55% of responders responding within 2 months.

Olutasidenib Maintains Durable Responses in IDH1+ AML for 5 Years

Tim Cortese
November 19th 2025
Article

Among all patients with AML enrolled in the trial who received olutasidenib, the CR or CRh rate was 35%, with 55% of responders responding within 2 months.