Introduction The heterogeneous molecular landscape of cytogenetically normal acute myeloid leukaemia (CN-AML) renders it an ongoing therapeutic challenge worldwide. The latest European LeukaemiaNet (ELN) 2017 guidelines attempt to address this by guiding post-remission therapy according to six prognostically informative mutations. However, its applicability in a South African setting remains elusive due to limited local data. This retrospective study aimed to describe a South African CN-AML cohort according to clinicopathological, molecular and treatment outcomes and consequently investigate the local applicability of a triple mutation testing approach for nucleophosmin (NPM1), fms-like tyrosine kinase internal tandem duplication (FLT3-ITD) and CCAAT/enhancer binding protein alpha (CEBPα) mutations in accordance with the ELN 2017 guidelines. Methods A review of cytogenetic results for all adult de novo AML cases diagnosed at Groote Schuur Hospital between 2005 and 2018 was performed. CN-AML cases were further characterized via molecular testing and review of clinical and laboratory data. Results In total, 218 patients with AML were identified of which fifty-six (33%) were cytogenetically normal. NPM1, FLT3-ITD and CEBPα mutations were found in 39%, 34% and 9% of CN-AML cases respectively, and allowed for definitive prognostication of 50% of cases. The 2-year overall survival rate for the entire CN-AML cohort was 16%. Conclusion Local rates of CN-AML and associated NPM1 and FLT3-ITD mutations were comparable to European cohorts. In contrast, local survival outcomes were notably inferior. Triple testing proved a resource effective prognostication approach for CN-AML. High throughput sequencing for adverse risk mutations should be considered for CN-AML patients inconclusively stratified via triple testing.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/36465 |
| Date | 10 June 2022 |
| Creators | Jenkins, Nicholas |
| Contributors | Shires, Karen |
| Publisher | Faculty of Health Sciences, Department of Clinical Laboratory Sciences |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Master Thesis, Masters, MMed |
| Format | application/pdf |
Page generated in 0.0042 seconds