(HealthDay News) — Residual variants are associated with a higher risk of relapse and death among patients with acute myeloid leukemia (AML) undergoing allogeneic hematopoietic stem cell transplant (HSCT) in first remission, according to a study published in the Journal of the American Medical Association.

The study showed that persistence of FLT3-ITD and NPM1 mutations in the blood during first remission was associated with a higher risk of relapse and death after allogeneic HSCT.

Researchers performed DNA sequencing on pretransplant blood from 1075 adults with AML who underwent their first allogeneic HSCT in first remission. A total of 822 patients had FLT3-ITD and/or NPM1 mutations.

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In a discovery cohort of 371 patients, the persistence of NPM1 mutations and/or FLT3-ITD in the blood prior to HSCT was associated with worse outcomes after HSCT.

In a validation cohort of 451 patients, those who had residual NPM1 mutations and/or FLT3-ITD had a higher risk of relapse at 3 years (hazard ratio [HR], 4.32; 95% CI, 2.98-6.26; P <.001) and a higher risk of death at 3 years (HR, 2.43; 95% CI, 1.71-3.45; P <.001).

“[T]he persistence of FLT3 internal tandem duplication or NPM1 variants in the blood at an allele fraction of 0.01% or higher was associated with increased relapse and worse survival compared with those without these variants,” the researchers concluded. “Further study is needed to determine whether routine DNA-sequencing testing for residual variants can improve outcomes for patients with acute myeloid leukemia.”

Several researchers disclosed financial ties to the pharmaceutical industry.

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