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Association of FLT3-ITD and NPM1 mutations with outcomes of allogeneic hematopoietic cell transplantation in acute myeloid leukemia

Bone Marrow Transplantation volume 60, pages 894–896 (2025)Cite this article

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The prognostic significance of the internal tandem duplication of FLT3 (FLT3-ITD) and NPM1 mutations is well-recognized in patients with acute myeloid leukemia (AML) treated with chemotherapy [1]. However, consensus regarding their effects on outcomes in those undergoing allogeneic hematopoietic cell transplantation (HCT) remains lacking. This study aimed to investigate the association of FLT3-ITD and NPM1 mutations with allogeneic HCT outcomes by analyzing the Japanese nationwide registry data of 732 patients with AML who underwent allogeneic HCT in complete remission (CR) during the contemporary period from 2019 to 2022. Data were obtained from the Transplant Registry Unified Management Program run by the Japanese Data Center for HCT in partnership with the Japanese Society for Transplantation and Cellular Therapy.

Inclusion criteria were patients with AML (excluding acute promyelocytic leukemia) aged ≥16 years at the time of transplantation who had undergone the first allogeneic HCT during the first or second CR from a matched related donor, a ≥7/8 matched unrelated donor, a single-unit umbilical cord blood graft, or a haploidentical related donor between 2019 and 2022, with available data on the presence or absence of both FLT3-ITD and NPM1 mutations. Further details of methods are described in Supplementary Methods.

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Fig. 1: Outcomes based on the presence or absence of FLT3-ITD and NPM1 mutations.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This work was supported in part by the Grants-in-Aid for Scientific Research from JSPS KAKENHI (grant number: JP24K11566) (M Yanada), and the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from the Japan Agency for Medical Research and Development (grant number: 19ek0510023h0003) (YA).

Author information

Authors and Affiliations

  1. Nagoya City University East Medical Center, Nagoya, Japan

    Masamitsu Yanada

  2. St. Mary’s Hospital, Kurume, Japan

    Satoshi Yamasaki

  3. Wakayama Medical University, Wakayama, Japan

    Hiroki Hosoi

  4. Aichi Medical University, Nagakute, Japan

    Shohei Mizuno, Marie Ohbiki & Yoshiko Atsuta

  5. Tokai University School of Medicine, Isehara, Japan

    Kaito Harada

  6. Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    Noriko Doki

  7. Jichi Medical University, Shimotsuke, Japan

    Shin-Ichiro Fujiwara & Yoshinobu Kanda

  8. Kobe City Medical Center General Hospital, Kobe, Japan

    Nobuhiro Hiramoto

  9. Hokkaido University Hospital, Sapporo, Japan

    Yuta Hasegawa

  10. Toranomon Hospital Kajigaya, Kawasaki, Japan

    Kazuya Ishiwata

  11. Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan

    Tetsuya Nishida

  12. Okayama University Hospital, Okayama, Japan

    Noboru Asada

  13. Yamagata University Hospital, Yamagata, Japan

    Takuma Suzuki

  14. University of Tsukuba Hospital, Tsukuba, Japan

    Mamiko Sakata-Yanagimoto

  15. Toranomon Hospital, Tokyo, Japan

    Naoyuki Uchida

  16. Kyoto University Hospital, Kyoto, Japan

    Junya Kanda

  17. Kagoshima University Hospital, Kagoshima, Japan

    Makoto Yoshimitsu

  18. National Cancer Center Hospital, Tokyo, Japan

    Takahiro Fukuda

  19. Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan

    Marie Ohbiki & Yoshiko Atsuta

  20. Nagoya University Graduate School of Medicine, Nagoya, Japan

    Marie Ohbiki

  21. The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    Takaaki Konuma

Authors
  1. Masamitsu Yanada
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  2. Satoshi Yamasaki
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  3. Hiroki Hosoi
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  4. Shohei Mizuno
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  5. Kaito Harada
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  6. Noriko Doki
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  7. Shin-Ichiro Fujiwara
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  8. Nobuhiro Hiramoto
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  9. Yuta Hasegawa
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  10. Kazuya Ishiwata
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  12. Noboru Asada
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  14. Mamiko Sakata-Yanagimoto
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  16. Junya Kanda
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  17. Makoto Yoshimitsu
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  18. Yoshinobu Kanda
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  19. Takahiro Fukuda
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  20. Marie Ohbiki
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  21. Yoshiko Atsuta
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  22. Takaaki Konuma
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Contributions

M Yanada designed the study, analyzed data, interpreted the results, and drafted the paper; SY, SM, HH, KH, ND, SF, NH, YH, KI, TN, NA, TS, MS, NU, JK, and TK interpreted the results and edited the paper; and M Yoshimitsu, YK, TF, MO, and YA contributed to data management, interpreted the results, and edited the paper. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Masamitsu Yanada.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

All methods were performed in accordance with the Declaration of Helsinki. This study was approved by the Nagoya City University Institutional Review Board, with the reference number 60-24-0030. All patients provided informed consent for the utilization of their clinical data for research.

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Yanada, M., Yamasaki, S., Hosoi, H. et al. Association of FLT3-ITD and NPM1 mutations with outcomes of allogeneic hematopoietic cell transplantation in acute myeloid leukemia. Bone Marrow Transplant 60, 894–896 (2025). https://doi.org/10.1038/s41409-025-02585-3

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