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We evaluated prognostic factors in 83 intensively treated adult patients with  NPM1  mutated AML. Targeted next-generation sequencing revealed high frequency of co-mutations in epigenetic modifiers or proliferation pathways.  NPM1  minimal residual disease (MRD), assessed in bone marrow by specific polymerase chain reaction after one chemotherapy course, was &gt;0.01% in 50 patients considered poor responders (PR). On multivariate analysis, including all variables with a  p  value &lt;.1 on univariate analysis, age &gt;60, performance status (PS) ≥1, presence of  FLT3  mutations,  DNMT3A -R882, and PR status, were independently associated with lower leukemia-free survival. Age &gt;60, a previous hematological disease and PR status were independent negative predictive factors for overall survival. In our study, early  NPM1  MRD was confirmed as an important prognostic factor. All  FLT3  and  DNMT3A -R882 mutations have also an independent prognostic value. We support the rational for in-depth investigations for a better approach in patients who achieving a first complete remission.

leukemia and lymphoma

Prognostic impact of early minimal residual disease combined with complete molecular evaluation in acute myeloid leukemia with mutated  NPM1 : a single center study