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Clinical implications of DNMT3A mutations in a Southeast Asian cohort of acute myeloid leukaemia patients. (J Clin Pathol, Jan 2017)

Tan M1, Ng IK1, Chen Z2, Ban K2, Ng C3, Chiu L3, Seah E4, Lin M3, Tai BC5, Yan B3, Ng CH4, Chng WJ4,6,7.

Department of Biochemistry, National University of Singapore, Singapore, Singapore.
Investigational Medicine Unit, National University Health System, Singapore, Singapore.
Department of Laboratory Medicine, Molecular Diagnosis Centre, National University Health System, Singapore, Singapore.
Department of Haematology-Oncology, National University Cancer Institute Singapore, National University Health System, Singapore, Singapore.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
Cancer Science Institute Singapore, National University of Singapore, Singapore, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Abstract
AIMS:
In recent years, genomic technologies have enabled the identification of mutations in acute myeloid leukaemia (AML). DNMT3A is a recurrently mutated epigenetic modifier gene in AML. To date, the prognostic significance of DNMT3A mutations has not been studied in a Southeast Asian AML population. We sought to investigate the clinical implications of DNMT3A mutations in a Southeast Asian cohort of AML patients.
METHODS:
DNMT3A mutations were identified using a targeted next-generation sequencing panel in 157 AML patients. We studied the molecular and clinical features of patients with DNMT3A mutations and assessed the prognostic impact of DNMT3A mutations.
RESULTS:
DNMT3A mutations were found in 33 of 157 (21.0%) AML patients. 114 patients were included for statistical analysis. Pretreatment data revealed that patients with DNMT3A mutations were older (≥60 years old), had a higher white blood cell count at diagnosis, had more adverse cytogenetic risk profiles and were more often associated with NPM1 mutations compared with patients with wild-type DNMT3A. Survival analysis showed that DNMT3A mutations were associated with poorer clinical outcomes. This was especially when associated with NPM1 and FLT3-ITD mutations (AMLNPM1/FLT3/DNMT3A), which are common. The AMLNPM1/FLT3/DNMT3A subtype was an independent predictor for poorer overall survival (OS). Other independent risk factors for poorer OS include advanced age at diagnosis and adverse cytogenetic risk stratification.

CONCLUSIONS:
DNMT3A mutations are associated with an unfavourable clinical outcome in our Southeast Asian AML patient cohort. In particular, AMLNPM1/FLT3/DNMT3A patients had the poorest prognosis.

KEYWORDS:
CANCER RESEARCH; HAEM-ONCOLOGY; diagnostic screening

PMID: 28100593