Review Article

The Impact of FLT3 Mutations on the Development of Acute Myeloid Leukemias

Table 1

Risk stratification of AMLs according to the FLT3-ITD status.

Cytogenetic classificationFLT3-ITD statusMutationsOverall risk profile

FavorableNegativet(15;17) (q22;q12)
PML-RARA
Favorable
FavorablePositive
(30–35% of cases)
t(15;17)(q22;q12)
PML-RARA
Usually favorable, but patients with long FLT3-ITD and low PML-RARA expression have less favorable prognosis and patients with high FLT3-ITD/FLT3-WT ratio
Intermediate or normal karyotypeNegativeDNMT3A mutationIntermediate
Intermediate or normal karyotypePositive (40% of cases)DNMT3A mutationUnfavorable
Intermediate or normal karyotypeNegativeNPM1 mutationFavorable
Intermediate or normal karyotypePositive (30–40% of cases)NPM1 mutationIntermediate (low FLT3-ITD/FLT3-WT ratio),
unfavorable (high FLT3-ITD/FLT3-WT ratio)
Intermediate or normal karyotypeNegativeNo NPM1 mutationUsually intermediate; unfavorable (some cases)
Intermediate or normal karyotypePositive (15–20% of cases)No NPM1 mutationIntermediate; unfavorable
(associated with a stemness signature)
Intermediate or normal karyotypeNegativeCEBPA double mutantFavorable
Intermediate or normal karyotypePositive (6% of cases)CEBPA double mutantIntermediate
Intermediate or normal karyotypeNegativeCEBPA single mutantUnfavorable
Intermediate or normal karyotypePositive (30–40% of cases)CEBPA single mutantUnfavorable
Intermediate or normal karyotypeNegativeMLL PTDUnfavorable
Intermediate or normal karyotypePositive (30–35% of cases)MLL PTDUnfavorable
UnfavorableNegative Various mutationsUnfavorable
UnfavorablePositive (6-7% of cases)Various mutationsUnfavorable