Mutation Profile And Prognostic Relevance In Elderly Patients With De Novo Acute Myeloid Leukemia Treated With Decitabine-Based Chemotherapy

Introduction Decitabine-based chemotherapy regimens have shown efficacy in the treatment of elderly patients with acute myeloid leukemia (AML). However, it remains unclear whether any molecular alteration is correlated with the therapeutic effect of such treatment regimens. Methods Gene mutations were detected using next-generation sequencing, and their impact on survival was investigated in elderly AML patients receiving decitabine-based chemotherapy. Results A higher incidence of gene mutations was identified in elderly AML patients than in the younger cohorts. Elderly patients more frequently carriedDNMT3A,IDH2,ASXL1,TET2,RUNX1,CEBPAsingle mutation (CEBPA(single-mut)), andTP53mutations. Survival analysis showed thatDNMT3A,FLT3-ITD, andTP53mutations were associated with inferior overall survival (OS) and event-free survival (EFS) in younger AML patients receiving standard treatment. However, in elderly patients treated with decitabine-based chemotherapy,FLT3-ITD, andASXL1mutations, but notDNMT3AandTP53mutations, were associated with poor OS and EFS. Moreover, contrary toCEBPAdouble mutation (CEBPA(double-mut)),CEBPA(single-mut)was identified as an unfavorable prognostic factor. Conclusion This study comprehensively analyzed the prognostic implications of gene mutations in elderly AML patients under decitabine-based treatment modality. Identification of genetic biomarkers to predict the subgroup of elderly AML patients who can benefit from decitabine-based regimens might have an immediate clinical utility to optimize the treatment of elderly AML patients.