Abstract:
Objective To determine the prognostic significance of PTPN11 mutation in patients with newly diagnosed acute myeloid leukemia (AML).
Methods A total of 526 patients newly diagnosed with AML (non-M3) were screened for gene mutations by whole-exome next generation sequencing. Then, the clinical characteristics, treatment efficacy, and patient survival rate were collected. Patients with PTPN11 mutation were categorized as the PTPN11mut group. The same number of non-PTPN11mut patients were selected as the control group (PTPN11wt), using 1:1 propensity score matching (PSM) for sex, age, and ELN 2017 risk stratification. The differences in efficacy, overall survival, and median relapse-free survival (mRFS) were compared between PTPN11mut and PTPN11wt groups.
Results PTPN11 mutations were detected in 51 (9.7%) of 526 patients newly diagnosed with AML, including 72 mutation types, all of which were missense mutations. NRAS, DNMT3A, FLT3, NPM1, and KRAS were the most frequently co-mutated genes of PTPN11. No significant differences were observed in the complete remission (CR) (70.8% vs. 56.3%, P=0.138) and overall response rates (ORR) (77.1% vs. 66.7%, P=0.256) between PTPN11mut and PTPN11wt groups after propensity score matching analysis. The mRFS time of patients with PTPN11mut was 19 months, significantly lower than that of patients with PTPN11wt (not reached, P=0.02), while the median overall survival (mOS) time (21.3 months vs. 31.4 months, P=0.416) did not differ significantly between the two groups. Thirteen patients in the PTPN11mut group underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). Moreover, the mOS (not reached vs. 11 months, P=0.001) and mRFS (not reached vs. 5.7 months, P=0.018) in this group were significantly longer than in those who did not receive allo-HSCT. Multivariate analysis showed that no allo-HSCT, failure to achieve CR at first induction, and relapse were independent and significant risk factors in the prognosis of AML patients with PTPN11 mutation (P<0.05).
Conclusions Patients with AML that exhibit PTPN11 mutation have a poor prognosis; allo-HSCT significantly improves the prognosis of these patients.