Page 75 - EJMO-9-3

Eurasian Journal of
Medicine and Oncology Molecular shift in FLT3 during AML course

Figure 1. Flowchart of study selection and inclusion based on eligibility criteria for systematic review
Abbreviation: PCR: Polymerase chain reaction.

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Shih et al. focused on data from FLT3-TKD and included mutation, 46 (5%) became negative, and 73 (8%) acquired
a robust patient cohort, providing valuable data to the the mutation during disease progression, indicating a 13%
analysis—particularly important given that TKD was the mutation shift rate (i.e., one in seven patients) (Figure 2).
least studied FLT3 mutation among the selected articles. In the subset of 543 patients with FLT3-TKD data
A total of 1,094 patients with relapsed or refractory (reported in only 10 studies), 14 (2%) retained the mutation,
AML were included. At diagnosis, 294 patients (26%) 20 (3%) lost it, and 15 (3%) acquired it at relapse—a shift
were FLT3-ITD-positive and 30 (3%) were FLT3-TKD- rate of 6%, or approximately one in 17 patients (Figure 3).
positive. At first relapse or refractory disease, 317 (29%) In addition, five cases of double mutation (FLT3-ITD/
were FLT3-ITD-positive and 31 (3%) were FLT3-TKD- TKD) exhibited dynamic changes; three patients were
positive, in agreement with data described in the literature. FLT3-ITD/TKD-positive at diagnosis and became FLT3-
A change in mutational status was observed in 147 patients
(13%), indicating that approximately one in seven ITD-positive with FLT-TKD negative; one patient acquired
patients experienced a shift in FLT3 status. Notably, 5% of the double mutation at relapse, and another one who at
patients had missing mutational data at relapse. Pediatric relapse became negative for both mutations.
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patients (n = 42) included in the study by Cloos et al. were Overall, 36% of the studied population tested positive for
excluded from the final analysis. the FLT3 mutation at some point during the disease course.
Among patients for whom FLT3-ITD evolution For a more accurate analysis, we extracted individual
could be evaluated (n = 936), 222 (24%) maintained the patient data, some of which included information on

Volume 9 Issue 3 (2025) 67 doi: 10.36922/EJMO025150101