Analysis of FLT3-activating mutations in 979 patients with acute myelogenous leukemia: association with FAB subtypes and identification of subgroups with.

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Analysis of FLT3-activating mutations in 979 patients with acute myelogenous leukemia: association with FAB subtypes and identification of subgroups with poor prognosis by Christian Thiede, Christine Steudel, Brigitte Mohr, Markus Schaich, Ulrike Schäkel, Uwe Platzbecker, Martin Wermke, Martin Bornhäuser, Markus Ritter, Andreas Neubauer, Gerhard Ehninger, and Thomas Illmer Blood Volume 99(12):4326-4335 June 15, 2002 ©2002 by American Society of Hematology

Prevalence of FLT3 mutations in different age groups and FAB-subtypes Prevalence of FLT3 mutations in different age groups and FAB-subtypes.(A) Percentage of patients with FLT3 mutations according to age cohorts. Prevalence of FLT3 mutations in different age groups and FAB-subtypes.(A) Percentage of patients with FLT3 mutations according to age cohorts. The number below each column gives the total number of patients in the respective cohort. (B) Prevalence of FLT3-ITDs in different FAB subtypes, given as a percentage of the total number of patients (mentioned above each column). Christian Thiede et al. Blood 2002;99:4326-4335 ©2002 by American Society of Hematology

PCR analysis of FLT3-ITDs and TKD mutations PCR analysis of FLT3-ITDs and TKD mutations.(A) Agarose gel electrophoresis of PCR with (lanes k, l, m, p) and without FLT3-ITDs. PCR analysis of FLT3-ITDs and TKD mutations.(A) Agarose gel electrophoresis of PCR with (lanes k, l, m, p) and without FLT3-ITDs. Lane q contains DNA of a normal donor, and lane r contains the water control. (B) The same set of samples analyzed for the FLT3 TKD mutation. Lanes f, h, and k showed an undigested band, arguing for a mutation. All 3 mutations were confirmed by sequencing. (C) Results of direct sequencing of PCR products obtained from patient UPN 03-066, corresponding to lane f in panel B, and UPN 23-031, corresponding to lane h in panel B. Note the residual wt FLT3 sequence visible in both samples. (D) Genescan analysis of FLT3-ITDs using denaturing PAA-gel electrophoresis and fluorescence detection. The ratio given for each sample denotes the relative proportion of the AUC of mutant and wt FLT3 alleles (ie, AUC FLT3-ITD/AUC FLT3-wt). Sample UPN 08-029 shows 3 different FLT3-ITDs of 355, 358, and 397 bp. Christian Thiede et al. Blood 2002;99:4326-4335 ©2002 by American Society of Hematology

Analysis of allelic loss in FLT3-ITD–positive samples Analysis of allelic loss in FLT3-ITD–positive samples.(A) FISH analysis of a patient with an allelic ratio of 3.65. Analysis of allelic loss in FLT3-ITD–positive samples.(A) FISH analysis of a patient with an allelic ratio of 3.65. Red signals denote the BAC 85P08 labeled with SpectrumRed, and the green signals indicate a commercial DNA FISH probe (LSI 13) containing the entire RB1 gene and regions telomeric to RB1 labeled with SpectrumGreen. Original magnification, × 125. (B) Results of the PCR assay to detect allelic loss at the FLT3 locus. The left graph denotes the results of the spiking experiment. A linear increase in the FLT3/HGH ratio was obtained after the addition of 1 to 3 pg BAC 85P08 DNA containing the FLT3 genomic locus,r 2 = 0.9895. The right graph shows the comparison of the allelic ratios obtained in healthy donors (HD; n = 22), patients with FLT3 wt/mutant ratios greater than 2 (FLT3-ITD; n = 12), and an AML patient with monosomy 13 (−13). Christian Thiede et al. Blood 2002;99:4326-4335 ©2002 by American Society of Hematology

Kaplan-Meier analysis of the OS and DFS in patients with AML with different FLT3 mutations.Comparison of (A) OS and (B) DFS in all patients with FLT3-ITD mutations, TKD mutations, both types of mutations (ITD+ and TKD mut.) and those with wt-FLT3. Kaplan-Meier analysis of the OS and DFS in patients with AML with different FLT3 mutations.Comparison of (A) OS and (B) DFS in all patients with FLT3-ITD mutations, TKD mutations, both types of mutations (ITD+ and TKD mut.) and those with wt-FLT3. (C) OS and (D) DFS in patients younger than 60 with de novo AML and intermediate-risk cytogenetics. Christian Thiede et al. Blood 2002;99:4326-4335 ©2002 by American Society of Hematology

Probability of relapse in patients with FLT3 mutations and different mutant/wt allelic ratios.Kaplan-Meier analysis of the probability of relapse in AML patients (60 and younger, de novo AML, and intermediate-risk cytogenetics). Probability of relapse in patients with FLT3 mutations and different mutant/wt allelic ratios.Kaplan-Meier analysis of the probability of relapse in AML patients (60 and younger, de novo AML, and intermediate-risk cytogenetics). (A) ITD, TKD, and both mutations (ITD+ and TKD mut.). (B) Grouped according to a mutant/wt ratio below (group A) or above (group B) the median of 0.78 compared to FLT3-ITD–negative patients (group C). (C) Probability of relapse in patients with a mutant/wt ratio 0.37 or lower (group 1), 0.37 to 0.95 (group 2), and greater than 0.95 (group 3) compared to FLT3-ITD–negative patients (group 4). Christian Thiede et al. Blood 2002;99:4326-4335 ©2002 by American Society of Hematology

Kaplan-Meier analysis of the OS and DFS in patients with AML, younger than 60, and with intermediate-risk cytogenetics.(A) Distribution of the mutant/wt allelic ratio and risk groups defined. Kaplan-Meier analysis of the OS and DFS in patients with AML, younger than 60, and with intermediate-risk cytogenetics.(A) Distribution of the mutant/wt allelic ratio and risk groups defined. (B) OS and (C) DFS for patients with a mutant/wt ratio below (group A) or above (group B) the median of 0.78 compared to FLT3-ITD–negative patients (group C). (D) DFS for patients with a mutant/wt ratio 0.37 or lower (group 1), 0.37 to 0.95 (group 2), and greater than 0.95 (group 3) compared with FLT3-ITD–negative patients (group 4). Christian Thiede et al. Blood 2002;99:4326-4335 ©2002 by American Society of Hematology