Effect of FMS﹣like tyrosine kinase 3 mutations on prognosis of acute promyelocytic leukemia: a Meta﹣analysis / 白血病·淋巴瘤

ABSTRACT

Objective To systematically evaluate the effect of FMS﹣like tyrosine kinase 3 (FLT3) mutations on prognosis of acute promyelocytic leukemia. Methods The databases of CNKI, Wanfang, VIP, China Biology Medicine disc, PubMed, EMBase, and Cochrane Library were retrieved, and the cohort studies and case﹣control studies published from the establishment of the databases to December 2017 were selected according to the inclusion and exclusion criteria. The quality assessment and data extraction was performed and the statistical analysis was performed by using RevMan 5.3 software. Results Twenty﹣three studies were included, covering a total of 2 632 patients. Meta﹣analysis showed that patients with FLT3 internal tandem duplication (FLT3﹣ITD) mutation had lower complete remission rate ( RR＝0.92, 95% CI 0.86-0.99, P＝0.02), 3﹣year overall survival rate ( RR＝0.72, 95% CI 0.60-0.88, P＝0.001) and 5﹣year overall survival rate ( RR＝0.89, 95% CI 0.81-0.99, P＝ 0.03), while the proportion of high﹣risk group ( RR＝ 3.13, 95% CI 2.26-4.35, P< 0.01), the early mortality rate ( RR＝ 2.26, 95% CI 1.75-2.90, P< 0.01) and the recurrence rate ( RR＝1.50, 95% CI 1.11-2.02, P＝0.008) were relatively high, and the differences were statistically significant. The patients with FLT3 tyrosine kinase domain (FLT3﹣TKD) mutation had higher early mortality rate ( RR＝ 3.00, 95% CI 1.74-5.20, P< 0.01), and the difference was statistically significant. Conclusion The FLT3 mutations can influence the prognosis of acute promyelocytic leukemia, which contributes to the research direction of better prognosis stratification, perfect treatment regimen and improved prognosis.