The Clinical impact of PTPN11 mutations in adults with acute myeloid leukemia

While germline and somatic mutations in the genePTPN11, encoding a phosphatase which regulates the RAS signaling pathway, are well characterized in children with Noonan syndrome and juvenile myelomonocytic leukemia, less is known about their clinical impact in adults with acute myeloid leukemia (AML). To elucidate the effect ofPTPN11mutations (PTPN11(mut)) on clinical outcomes, we screened adult patients with AML treated at our institution using targeted next-generation sequencing. Among 1406 consecutive patients, 112 (8%) hadPTPN11(mut). These mutations were more commonly associated with the acute myelomonocytic/monocytic leukemia subtype than was wild-typePTPN11, while none were detected in patients with core-binding factor AML. They co-occurred more commonly withNPM1mutations andFLT3internal tandem duplications and less commonly with mutations inIDH2and a complex karyotype. Compared with the wild-type allele,PTPN11(mut)was associated with lower complete response rates (54% vs 40%;P = 0.04), and shorter overall survival (median 13.6 vs 8.4 months;P = 0.008). In a multivariate analysis,PTPN11(mut)independently increased the risk of death, with a hazard ratio of 1.69 (95% CI, 1.25-2.29;P = 0.0007). In summary, mutations inPTPN11have a characteristic phenotype in adults with AML and are associated with an adverse prognosis.