Hematologic Oncology Update, Issue 3, 2016 (Video Program) - Video 16Approach to FLT3 and other mutation testing for patients with AML
1:49 minutes.
TRANSCRIPTION:
DR TIBES: There are guidelines — and I can tell you how I practice and what are my approaches. And I will tell you why. So the baseline is, after the diagnosis of leukemia for sure, cytogenetics, conventional cytogenetics or FISH, an AML-specific FISH, and for diploid cytogenetic patients, meaning a normal karyotype, doing NPM1 and FLT3 mutations. So that’s the common standard. However, there are other subgroups, including the favorable-risk leukemias — that’s the translocation 8;21 or the inversion 16 — where quite a number of patients, up to 10% to 20%, also have other mutations, including FLT3. So I had a few patients, younger patients in their thirties or forties, with favorable karyotype AML — that’s the 8;21 and another patient with inversion 16 — and they actually did have an FLT3 mutation and the FLT3 TKD mutation. And those patients actually have an intermediate prognosis, so they’re not that favorable anymore. They’re not doing as poorly as an unfavorable karyotype or diploid karyotype with an FLT3. However, those patients, I have seen them relapse if they had an FLT3 mutation, particularly the TKD. So we also channel those patients individually. We make an individual decision on those patients. And we send them to transplant sometimes, based on the donor status and based on their tolerance and based on their response. So I would advocate to do FLT3 testing for most patients up front. Why? Because we also have a drug available, or we do have therapies available. So I do think it makes a difference. I’m not opting, I’m not advocating for testing everything, but if we have medications available now, targeted therapies, I do think it makes a difference. And I would test for those. |