A 55-year-old man is diagnosed with acute myeloid leukemia. Cytogenetics show a normal karyotype. Molecular testing reveals an internal tandem duplication in the FLT3 gene (FLT3-ITD). What is the prognostic significance of this finding?
- A Favorable prognosis with high remission rates using standard induction
- B Adverse prognosis with increased relapse risk; allogeneic transplant considered in first CR ✓
- C Intermediate prognosis; no impact on treatment selection
- D Neutral prognosis; only relevant in relapsed or refractory disease
Correct answer: B. Adverse prognosis with increased relapse risk; allogeneic transplant considered in first CR
Explanation
FLT3-ITD in AML with normal cytogenetics confers an adverse prognosis with higher relapse rates and inferior overall survival. Current ELN and NCCN guidelines classify this as adverse risk, warranting allogeneic hematopoietic stem cell transplantation in first complete remission when feasible. Midostaurin is approved as adjunct therapy for FLT3-mutated AML.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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