The clinical significance of FLT3 ITD mutation on the prognosis of adult acute promyelocytic leukemia

Background and aims: To explore the relationship between FLT3 (encoding Fms related tyrosine kinase 3) internal tandem duplication (ITD) mutations with the prognosis of acute promyelocytic leukemia. The PubMed database, the Cochrane Library, conference proceedings, the EMBASE databases, and references of published trials and review articles were searched. Two reviewers independently assessed the quality of the trials and extracted the data. Odd ratios (ORs) for complete remission (CR) rate after induction therapy, 5-year overall survival (OS), and 5-year disease free survival (DFS) were pooled using the STATA package. Main results: Seventeen trials involving 2252 patients were ultimately analyzed. The pooled OR showed that the FLT3 ITD mutation group had a poor prognosis in terms of CR rate (OR = 0.53, 95% confidence interval (CI), 0.30-0.95, P= 0.03), 5-year OS (OR = 0.47, 95% CI, 0.29-0.75, P= 0.002), and as 5-year DFS (OR = 0.48, 95% CI, 0.29-0.78; p= 0.003). Conclusions: The results suggested that FLT3 ITD mutations could become an indicator of poor prognosis of APL, and these patients should receive more intensive therapy according to current guidelines.