The value of molecular stratification for CEBPA(DM) and NPM1(MUT) FLT3(WT) genotypes in older patients with acute myeloid leukaemia.

Older adult patients (60years) with acute myeloid leukaemia (AML) are generally considered to be poor-risk and there is limited information available regarding risk stratification based on molecular characterization in this age group, particularly for the double-mutant CEBPA (CEBPA(DM)) genotype. To investigate whether a molecular favourable-risk genotype can be identified, we investigated CEBPA, NPM1 and FLT3 status and prognostic impact in a cohort of 301 patients aged 60years or more with intermediate-risk cytogenetics, all treated intensively. Overall survival (OS) at 1year was highest in the 12 patients (4%) that were CEBPA(DM) compared to the 76 (28%) with a mutant NPM1 and wild-type FLT3 (NPM1(MUT)FLT3(WT)) genotype or all other patients (75%, 54%, 33% respectively), with median survival 152, 136 and 66months, although the benefit was short-term (OS at 3years 17%, 29%, 12% respectively). Combination of the CEBPA(DM) and NPM1(MUT)FLT3(WT) genotype patients defined a molecular group with favourable prognosis (P<00001 in multivariate analysis), with 57% of patients alive at 1year compared to 33% for all other patients. Knowledge of genotype in older cytogenetically intermediate-risk patients might influence therapy decisions.