Annals of Hematology

, Volume 91, Issue 11, pp 1703–1712 | Cite as

FLT3 and NPM1 mutations in a cohort of AML patients and detection of a novel mutation in tyrosine kinase domain of FLT3 gene from Western India

  • Kanjaksha Ghosh
  • Suchitra Swaminathan
  • Manisha Madkaikar
  • Maya Gupta
  • Lily Kerketta
  • Baburao Vundinti
Original Article

Abstract

Acute myeloid leukemia (AML) is an aggressive hematological disorder characterized by the loss of ability of the hematopoietic progenitor cells to differentiate and proliferate normally leading to an accumulation of immature myeloid cells in the bone marrow. Several novel molecular genetic aberrations in FLT3 and NPM1 have been shown to have a prognostic impact in AML, particularly in those having normal karyotype. Though there is substantial amount of data on these mutations from western literature, there is surprisingly little data from Indian subcontinent on the frequency of this mutation in AML patients from India. The present study screens a large cohort of non-acute promyelocytic leukemia (APL) AML patients (207 patients) for the presence of FLT3 and NPM1 mutations and further correlates with cytogenetics, immunophenotypic characteristics and with follow-up data wherever available. During the course of study, 56 APL patients were also studied. Briefly, both FLT3 (internal tandem duplication (ITD) in 19.4 % and tyrosine kinase domain (TKD) in 9 %) and NPM1 mutations were detected in 28.4 % of the total non-APL AML patients screened showing distinct correlations with hematologic, immunophenotypic, cytogenetics characteristics and follow-up. With regards to adult APL patients, 22.2 and 32.6 % of the patients showed FLT3 and NPM1 mutation, respectively. In the pediatrics age group (<15 years), 23 and16 % of patients with APL showed FLT3 and NPM1 mutation, respectively, while in non-APL patient is this age group, 23 % of patients showed both FLT3 and NPM1 mutation. NPM1 mutation was distinctly uncommon in younger age group of patients. In contrast to report elsewhere, most of our FLT3 mutation was in exon 11 rather than in exon 12. FLT3mutation due to ITD or TKD mutation was detected in 2:1 ratio in our patients and a new TKD mutation was also detected S840G in an M5 patient who did not go into remission and had a short survival of 3 months from diagnosis. Generally, patients with NPM1 mutation had a very high white cell count but they went into remission more often than those with wild (Wt)-type allele (written as NPM1− and FLT3−, respectively) and FLT3 mutation. These patients also tended to have significantly lower expression of CD34 antigen on flowcytometry. Distinct prognostic subclasses of adult AML patients were identified based on the presence of NPM1 and FLT3 mutations.

Keywords

AML FLT3 mutations NPM1 mutations 

Notes

Acknowledgments

The authors want to thank Dr. Srimati Shetty, Dr. Sonal Vora, Dr. Mansi Vijapurkar Dr. Bipin Kulkarni, Ms. Seema Korgaonkar, and Ms. Leena Sonawane (NIIH-ICMR) for invaluable contributions to the progression of these studies. Ms. Swati Garg provided considerable help during revision of this paper.

Conflicts of interest

The authors declare no competing financial interests.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Kanjaksha Ghosh
    • 1
  • Suchitra Swaminathan
    • 1
  • Manisha Madkaikar
    • 1
  • Maya Gupta
    • 1
  • Lily Kerketta
    • 1
  • Baburao Vundinti
    • 1
  1. 1.Indian Council of Medical Research (ICMR)National Institute of ImmunohaematologyMumbaiIndia

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