Table 1.
Patient | Karyotype | Mutations, fusions | ELN category | SAMHD1 IHC | CR cycle 1/2 | MRD after cycle 2, flow cytometry/RT‐qPCR/deep sequencing | Allo‐HSCT | Time to relapse (months) | Overall survival (months) |
---|---|---|---|---|---|---|---|---|---|
1101 Female 26 years |
47,XX,t(8;19)(p21;p10),+der(8)t(8;19) [14] /46,idem,‐7 [3] /48,idem,+21 [2] /46,XX [1] | RUNX1 | Adverse | 25%–75% | Yes/Yes | 0.02%/NA/RUNX1 8.9% | Yes | NA | 20.5+ |
1102 Female 27 years |
46,XX [20] | NRAS, U2AF1 | Intermediate | <25% | Yes/Yes | 0.07%/NA/U2AF1 0.4%, NRAS <0.02% | Yes | NA | 20.1+ |
1103 Male 26 years |
46,XY [20] | FLT3‐TKD, RUNX1, IKZF1 | Adverse | 25%–75% | Yes/Yes | 0.09%/NA/RUNX1 0.74%, FLT3‐TKD 0.049% | Yes | NA | 19.2+ |
1104 Female 26 years |
46,XX,t(6;9)(p22;q34) [17] /46,XX [3] | DEK::NUP214 | Adverse | <25% | Yes/Yes | NA/<0.01%/NA | Yes | NA | 18.6+ |
1105 Female 48 years |
46,XX [20] | NPM1, FLT3‐TKD, IDH2, DNMT3A | Favourable | >75% | Yes/Yes | NA/<0.001%/NA | No | NA | 18.0+ |
1106 Male 76 years |
46,XY [20] | RUNX1, BCORL1, BCOR, FLT3‐TKD | Adverse | 25%–75% | No a /Yes | 0.004%/NA/RUNX1 10.5%, FLT3‐TKD 0.004% | No | 11.9 | 16.8+ |
1107 Male 52 years |
46,XY [20] | NPM1, FLT3‐ITD low ratio, IDH2 | Favourable | <25% | Yes/Yes | NA/0.0017/NA | No | NA b | 16.7+ |
1108 Female 61 years |
45,X,‐X [10]/46,XX [10] | RUNX1, SF3B1, CBL | Adverse | <25% | Yes/Yes | NA c /NA/RUNX1 0.79%, CBL 0.77% | Yes | NA | 16.0+ |
1109 Female 61 years |
46,XX t(5;6)(q31;q25) [6] /46,XX [16] | NPM1, FLT3‐ITD low ratio, TET2 | Favourable d | <25% | Yes/Yes | NA/0.017%/NA | Yes | NA | 14.9+ |
Abbreviations: Allo‐HSCT, allogeneic haematopoietic stem cell transplantation; BCOR, BCL6 Corepressor; BCORL1, BCL6 Corepressor Like 1; CBL, Cbl Proto‐Oncogene; CR, complete remission; DEK::NUP214, fusion of DEK Proto‐Oncogene and Nucleoporin 214; DNMT3A, DNA Methyltransferase 3α; ELN, European LeukemiaNet; FLT3‐ITD, Fms Related Receptor Tyrosine Kinase 3 internal tandem duplication; FLT3‐TKD, Fms Related Receptor Tyrosine Kinase 3 tyrosine kinase domain; IDH2, Isocitrate Dehydrogenase 2; IHC, immunohistochemistry; IKZF1, IKAROS Family Zinc Finger 1; MRD, measurable residual disease; NA, not available; NPM1, Nucleophosmin 1; NRAS, Neuroblastoma RAS viral oncogene homolog; RUNX1, Runt‐related transcription factor 1; SF3B1, Splicing Factor 3b Subunit 1; TET2, Tet Methylcytosine Dioxygenase 2; U2AF1, U2 Small Nuclear RNA Auxiliary Factor 1.
Blasts 5.5%; Granulocyte colony‐stimulating factor use prior to sampling may have increased the morphologic blast count.
At 9 months, MRD NPM1 switched from negative to positive at 0.00024%, when double‐checked then negative. Prior to receiving the confirmatory MRD result, the patient was put on AZA‐VEN and received three cycles.
Patient 1108 lacked a leukaemia‐specific phenotype for flow cytometry.
This patient had a prior history of myeloproliferative neoplasia with osteosclerosis and extramedullary haematopoiesis, and therefore better resembled a higher‐risk secondary AML.