Treatment-influenced associations of PML-RARα mutations, FLT3 mutations and additional chromosome abnormalities in relapse acute promyelocytic leukemia.

Publication Type:

Journal Article


Blood (2012)


256, Center-Authored Paper, Clinical Research Division, July 2012


Mutations in the all-trans retinoic acid(ATRA)-targeted ligand binding domain of PML-RARα (PRα/LBD(+)) have been implicated in the passive selection of ATRA-resistant acute promyelocytic leukemia (APL) clones leading to disease relapse. Among 45 relapse patients from the ATRA/chemotherapy(CT)-arm of intergroup protocol C9710, 18 patients harbored PRα/LBD(+) (40%), 7 of whom (39%) relapsed off ATRA selection pressure, suggesting a possible active role of PRα/LBD(+). Of 41 relapse patients co-analyzed, 15 (37%) had FMS-related tyrosine kinase 3 internal tandem duplication mutations (FLT3-ITD(+)), which were differentially associated with PRα/LBD(+) depending on ATRA treatment status at relapse: positively, On-ATRA; negatively, Off-ATRA. Thirteen of 21 patients (62%) had additional chromosome abnormalities (ACA); all co-analyzed PRα/LBD mutant patients who relapsed off-ATRA (n=5) had associated ACA. After relapse Off-ATRA, ACA and FLT3-ITD(+) were negatively associated and were oppositely associated with presenting white blood count and PML-RARα type: ACA, low, L-isoform; FLT3-ITD(+), high, S-isoform. These exploratory results suggest that differing PRα/LBD(+) activities may interact with FLT3-ITD(+) or ACA, that FLT3-ITD(+) and ACA are associated with different intrinsic disease progression pathways manifest at relapse Off-ATRA and that these different pathways may be short-circuited by ATRA-selectable defects at relapse On-ATRA. ACA and certain PRα/LBD(+) were also associated with reduced post-relapse survival.