Influence of FLT3‐internal tandem duplication allele burden and white blood cell count on the outcome in patients with intermediate‐risk karyotype acute myeloid leukemia
BACKGROUND: In patients with acute myeloid leukemia (AML), testing for fms‐like tyrosine kinase‐3 (FLT3)–internal tandem duplication (FLT3‐ITD) and nucleophosmin‐1 (NPM1) mutations can allow for further prognostic subclassification, but less is known about the effects of FLT3‐ITD allele burden and p...
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| Veröffentlicht in: | Cancer 2012-12, Vol.118 (24), p.6110-6117 |
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| creator | How, Jonathan Sykes, Jenna Gupta, Vikas Yee, Karen W. L. Schimmer, Aaron D. Schuh, Andre C. Minden, Mark D. Kamel‐Reid, Suzanne Brandwein, Joseph M. |
| description | BACKGROUND:
In patients with acute myeloid leukemia (AML), testing for fms‐like tyrosine kinase‐3 (FLT3)–internal tandem duplication (FLT3‐ITD) and nucleophosmin‐1 (NPM1) mutations can allow for further prognostic subclassification, but less is known about the effects of FLT3‐ITD allele burden and presenting white blood cell count (WBC) within molecular subgroups.
METHODS:
The authors retrospectively assessed 206 adult patients who had AML with an intermediate‐risk karyotype and who received treatment on a uniform induction and consolidation chemotherapy regimen.
RESULTS:
The presenting WBC was a prognostic factor for survival only in patients who had an FLT3‐ITD mutation. On multivariate analysis, after correcting for age, WBC, secondary AML, and blast percentage, nucleophosmin‐1 (NPM1)‐mutated/FLT3‐ITD–negative patients had superior overall survival compared with patients in the other molecular subgroups. Patients who had FLT3‐ITD mutations had an inferior overall survival compared with patients who had NPM1 wild‐type/FLT3‐negative disease, and patients who had low or intermediate levels of the FLT‐ITD of mutant allele had overall and disease‐free survival similar to those in patients who had high‐level mutations.
CONCLUSIONS:
NPM1 and FLT3‐ITD status, age, WBC, and secondary AML were identified as important prognostic variables that can help to risk stratify patients with AML who have intermediate‐risk cytogenetics. FLT3 allele burden had no significant influence on outcomes after correcting for other variables. Cancer 2012. © 2012 American Cancer Society.
In patients with acute myeloid leukemia and intermediate‐risk cytogenetics, the white blood cell count at presentation is identified as the only prognostic factor for patients who have mutations in the fms‐like tyrosine kinase‐3–internal tandem duplication (FLT3‐ITD) gene. Correcting for the white blood count, FLT3‐ITD allele burden does not correlate with survival. |
| doi_str_mv | 10.1002/cncr.27683 |
| format | Article |
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In patients with acute myeloid leukemia (AML), testing for fms‐like tyrosine kinase‐3 (FLT3)–internal tandem duplication (FLT3‐ITD) and nucleophosmin‐1 (NPM1) mutations can allow for further prognostic subclassification, but less is known about the effects of FLT3‐ITD allele burden and presenting white blood cell count (WBC) within molecular subgroups.
METHODS:
The authors retrospectively assessed 206 adult patients who had AML with an intermediate‐risk karyotype and who received treatment on a uniform induction and consolidation chemotherapy regimen.
RESULTS:
The presenting WBC was a prognostic factor for survival only in patients who had an FLT3‐ITD mutation. On multivariate analysis, after correcting for age, WBC, secondary AML, and blast percentage, nucleophosmin‐1 (NPM1)‐mutated/FLT3‐ITD–negative patients had superior overall survival compared with patients in the other molecular subgroups. Patients who had FLT3‐ITD mutations had an inferior overall survival compared with patients who had NPM1 wild‐type/FLT3‐negative disease, and patients who had low or intermediate levels of the FLT‐ITD of mutant allele had overall and disease‐free survival similar to those in patients who had high‐level mutations.
CONCLUSIONS:
NPM1 and FLT3‐ITD status, age, WBC, and secondary AML were identified as important prognostic variables that can help to risk stratify patients with AML who have intermediate‐risk cytogenetics. FLT3 allele burden had no significant influence on outcomes after correcting for other variables. Cancer 2012. © 2012 American Cancer Society.
In patients with acute myeloid leukemia and intermediate‐risk cytogenetics, the white blood cell count at presentation is identified as the only prognostic factor for patients who have mutations in the fms‐like tyrosine kinase‐3–internal tandem duplication (FLT3‐ITD) gene. Correcting for the white blood count, FLT3‐ITD allele burden does not correlate with survival.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/cncr.27683</identifier><identifier>PMID: 22736495</identifier><identifier>CODEN: CANCAR</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>acute myeloid leukemia ; Adult ; Aged ; Alleles ; Biological and medical sciences ; chemotherapy ; Female ; FLT3 mutations ; fms-Like Tyrosine Kinase 3 - genetics ; fms‐like tyrosine kinase‐3 ; Follow-Up Studies ; Gene Duplication ; Hematologic and hematopoietic diseases ; Humans ; Karyotyping ; leukemia ; Leukemia, Myeloid, Acute - drug therapy ; Leukemia, Myeloid, Acute - genetics ; Leukemia, Myeloid, Acute - mortality ; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis ; Leukocyte Count ; Male ; Medical sciences ; Middle Aged ; Mutation - genetics ; Neoplasm Staging ; NPM1 mutations ; Nuclear Proteins - genetics ; nucleophosmin‐1 ; Prognosis ; Retrospective Studies ; Survival Rate ; Tandem Repeat Sequences - genetics ; Tumors ; Young Adult</subject><ispartof>Cancer, 2012-12, Vol.118 (24), p.6110-6117</ispartof><rights>Copyright © 2012 American Cancer Society</rights><rights>2014 INIST-CNRS</rights><rights>Copyright © 2012 American Cancer Society.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3953-6ca669d0b688ebec38604c0c2c60fa613a021955b7cfc582cd5b2191c87a0daa3</citedby><cites>FETCH-LOGICAL-c3953-6ca669d0b688ebec38604c0c2c60fa613a021955b7cfc582cd5b2191c87a0daa3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fcncr.27683$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fcncr.27683$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26711820$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22736495$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>How, Jonathan</creatorcontrib><creatorcontrib>Sykes, Jenna</creatorcontrib><creatorcontrib>Gupta, Vikas</creatorcontrib><creatorcontrib>Yee, Karen W. L.</creatorcontrib><creatorcontrib>Schimmer, Aaron D.</creatorcontrib><creatorcontrib>Schuh, Andre C.</creatorcontrib><creatorcontrib>Minden, Mark D.</creatorcontrib><creatorcontrib>Kamel‐Reid, Suzanne</creatorcontrib><creatorcontrib>Brandwein, Joseph M.</creatorcontrib><title>Influence of FLT3‐internal tandem duplication allele burden and white blood cell count on the outcome in patients with intermediate‐risk karyotype acute myeloid leukemia</title><title>Cancer</title><addtitle>Cancer</addtitle><description>BACKGROUND:
In patients with acute myeloid leukemia (AML), testing for fms‐like tyrosine kinase‐3 (FLT3)–internal tandem duplication (FLT3‐ITD) and nucleophosmin‐1 (NPM1) mutations can allow for further prognostic subclassification, but less is known about the effects of FLT3‐ITD allele burden and presenting white blood cell count (WBC) within molecular subgroups.
METHODS:
The authors retrospectively assessed 206 adult patients who had AML with an intermediate‐risk karyotype and who received treatment on a uniform induction and consolidation chemotherapy regimen.
RESULTS:
The presenting WBC was a prognostic factor for survival only in patients who had an FLT3‐ITD mutation. On multivariate analysis, after correcting for age, WBC, secondary AML, and blast percentage, nucleophosmin‐1 (NPM1)‐mutated/FLT3‐ITD–negative patients had superior overall survival compared with patients in the other molecular subgroups. Patients who had FLT3‐ITD mutations had an inferior overall survival compared with patients who had NPM1 wild‐type/FLT3‐negative disease, and patients who had low or intermediate levels of the FLT‐ITD of mutant allele had overall and disease‐free survival similar to those in patients who had high‐level mutations.
CONCLUSIONS:
NPM1 and FLT3‐ITD status, age, WBC, and secondary AML were identified as important prognostic variables that can help to risk stratify patients with AML who have intermediate‐risk cytogenetics. FLT3 allele burden had no significant influence on outcomes after correcting for other variables. Cancer 2012. © 2012 American Cancer Society.
In patients with acute myeloid leukemia and intermediate‐risk cytogenetics, the white blood cell count at presentation is identified as the only prognostic factor for patients who have mutations in the fms‐like tyrosine kinase‐3–internal tandem duplication (FLT3‐ITD) gene. Correcting for the white blood count, FLT3‐ITD allele burden does not correlate with survival.</description><subject>acute myeloid leukemia</subject><subject>Adult</subject><subject>Aged</subject><subject>Alleles</subject><subject>Biological and medical sciences</subject><subject>chemotherapy</subject><subject>Female</subject><subject>FLT3 mutations</subject><subject>fms-Like Tyrosine Kinase 3 - genetics</subject><subject>fms‐like tyrosine kinase‐3</subject><subject>Follow-Up Studies</subject><subject>Gene Duplication</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Humans</subject><subject>Karyotyping</subject><subject>leukemia</subject><subject>Leukemia, Myeloid, Acute - drug therapy</subject><subject>Leukemia, Myeloid, Acute - genetics</subject><subject>Leukemia, Myeloid, Acute - mortality</subject><subject>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</subject><subject>Leukocyte Count</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mutation - genetics</subject><subject>Neoplasm Staging</subject><subject>NPM1 mutations</subject><subject>Nuclear Proteins - genetics</subject><subject>nucleophosmin‐1</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Survival Rate</subject><subject>Tandem Repeat Sequences - genetics</subject><subject>Tumors</subject><subject>Young Adult</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU2KFEEQhQtRnHZ04wEkN4IINeZP_S6lmdGBRkFGcFdkRUbRaWdllvlD0zuP4EW8lCcxe7rVnbEJIvh4j8criueMXjFK-Ruw4K9423TiQbFitG9Lyir-sFhRSruyrsSXi-JJCF_z2fJaPC4uOG9FU_X1qvh5ayeT0AISN5GbzZ349f2HthG9lYZEaRXORKXFaJBRO0ukMWiQjMkrzJdVZL_VMT-Mc4oAGkPAJRtJZuM2q6YIbkaiLVmyAtoYyF7HLbk3mVFpGTF7eh12ZCf9wcXDgkRCyqLzAY3TihhMO5y1fFo8mqQJ-Oy8L4vPN9d36_fl5uO72_XbTQmir0XZgGyaXtGx6TocEUTX0AoocGjoJBsmJOWsr-uxhQnqjoOqx_xg0LWSKinFZfHqpLt49y1hiMOswzGbtOhSGBjPIxivuoy-PqHgXQgep2Hxes45BkaHYz3DsZ7hvp4MvzjrpjFH_4v-6SMDL8-ADCDN5KUFHf5xTctYx2nm2Inba4OH_1gO6w_rTyfz3xkdraI</recordid><startdate>20121215</startdate><enddate>20121215</enddate><creator>How, Jonathan</creator><creator>Sykes, Jenna</creator><creator>Gupta, Vikas</creator><creator>Yee, Karen W. L.</creator><creator>Schimmer, Aaron D.</creator><creator>Schuh, Andre C.</creator><creator>Minden, Mark D.</creator><creator>Kamel‐Reid, Suzanne</creator><creator>Brandwein, Joseph M.</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><general>Wiley-Blackwell</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20121215</creationdate><title>Influence of FLT3‐internal tandem duplication allele burden and white blood cell count on the outcome in patients with intermediate‐risk karyotype acute myeloid leukemia</title><author>How, Jonathan ; Sykes, Jenna ; Gupta, Vikas ; Yee, Karen W. L. ; Schimmer, Aaron D. ; Schuh, Andre C. ; Minden, Mark D. ; Kamel‐Reid, Suzanne ; Brandwein, Joseph M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3953-6ca669d0b688ebec38604c0c2c60fa613a021955b7cfc582cd5b2191c87a0daa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>acute myeloid leukemia</topic><topic>Adult</topic><topic>Aged</topic><topic>Alleles</topic><topic>Biological and medical sciences</topic><topic>chemotherapy</topic><topic>Female</topic><topic>FLT3 mutations</topic><topic>fms-Like Tyrosine Kinase 3 - genetics</topic><topic>fms‐like tyrosine kinase‐3</topic><topic>Follow-Up Studies</topic><topic>Gene Duplication</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Humans</topic><topic>Karyotyping</topic><topic>leukemia</topic><topic>Leukemia, Myeloid, Acute - drug therapy</topic><topic>Leukemia, Myeloid, Acute - genetics</topic><topic>Leukemia, Myeloid, Acute - mortality</topic><topic>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</topic><topic>Leukocyte Count</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mutation - genetics</topic><topic>Neoplasm Staging</topic><topic>NPM1 mutations</topic><topic>Nuclear Proteins - genetics</topic><topic>nucleophosmin‐1</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Survival Rate</topic><topic>Tandem Repeat Sequences - genetics</topic><topic>Tumors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>How, Jonathan</creatorcontrib><creatorcontrib>Sykes, Jenna</creatorcontrib><creatorcontrib>Gupta, Vikas</creatorcontrib><creatorcontrib>Yee, Karen W. L.</creatorcontrib><creatorcontrib>Schimmer, Aaron D.</creatorcontrib><creatorcontrib>Schuh, Andre C.</creatorcontrib><creatorcontrib>Minden, Mark D.</creatorcontrib><creatorcontrib>Kamel‐Reid, Suzanne</creatorcontrib><creatorcontrib>Brandwein, Joseph M.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>How, Jonathan</au><au>Sykes, Jenna</au><au>Gupta, Vikas</au><au>Yee, Karen W. L.</au><au>Schimmer, Aaron D.</au><au>Schuh, Andre C.</au><au>Minden, Mark D.</au><au>Kamel‐Reid, Suzanne</au><au>Brandwein, Joseph M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influence of FLT3‐internal tandem duplication allele burden and white blood cell count on the outcome in patients with intermediate‐risk karyotype acute myeloid leukemia</atitle><jtitle>Cancer</jtitle><addtitle>Cancer</addtitle><date>2012-12-15</date><risdate>2012</risdate><volume>118</volume><issue>24</issue><spage>6110</spage><epage>6117</epage><pages>6110-6117</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><coden>CANCAR</coden><abstract>BACKGROUND:
In patients with acute myeloid leukemia (AML), testing for fms‐like tyrosine kinase‐3 (FLT3)–internal tandem duplication (FLT3‐ITD) and nucleophosmin‐1 (NPM1) mutations can allow for further prognostic subclassification, but less is known about the effects of FLT3‐ITD allele burden and presenting white blood cell count (WBC) within molecular subgroups.
METHODS:
The authors retrospectively assessed 206 adult patients who had AML with an intermediate‐risk karyotype and who received treatment on a uniform induction and consolidation chemotherapy regimen.
RESULTS:
The presenting WBC was a prognostic factor for survival only in patients who had an FLT3‐ITD mutation. On multivariate analysis, after correcting for age, WBC, secondary AML, and blast percentage, nucleophosmin‐1 (NPM1)‐mutated/FLT3‐ITD–negative patients had superior overall survival compared with patients in the other molecular subgroups. Patients who had FLT3‐ITD mutations had an inferior overall survival compared with patients who had NPM1 wild‐type/FLT3‐negative disease, and patients who had low or intermediate levels of the FLT‐ITD of mutant allele had overall and disease‐free survival similar to those in patients who had high‐level mutations.
CONCLUSIONS:
NPM1 and FLT3‐ITD status, age, WBC, and secondary AML were identified as important prognostic variables that can help to risk stratify patients with AML who have intermediate‐risk cytogenetics. FLT3 allele burden had no significant influence on outcomes after correcting for other variables. Cancer 2012. © 2012 American Cancer Society.
In patients with acute myeloid leukemia and intermediate‐risk cytogenetics, the white blood cell count at presentation is identified as the only prognostic factor for patients who have mutations in the fms‐like tyrosine kinase‐3–internal tandem duplication (FLT3‐ITD) gene. Correcting for the white blood count, FLT3‐ITD allele burden does not correlate with survival.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>22736495</pmid><doi>10.1002/cncr.27683</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | acute myeloid leukemia Adult Aged Alleles Biological and medical sciences chemotherapy Female FLT3 mutations fms-Like Tyrosine Kinase 3 - genetics fms‐like tyrosine kinase‐3 Follow-Up Studies Gene Duplication Hematologic and hematopoietic diseases Humans Karyotyping leukemia Leukemia, Myeloid, Acute - drug therapy Leukemia, Myeloid, Acute - genetics Leukemia, Myeloid, Acute - mortality Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis Leukocyte Count Male Medical sciences Middle Aged Mutation - genetics Neoplasm Staging NPM1 mutations Nuclear Proteins - genetics nucleophosmin‐1 Prognosis Retrospective Studies Survival Rate Tandem Repeat Sequences - genetics Tumors Young Adult |
| title | Influence of FLT3‐internal tandem duplication allele burden and white blood cell count on the outcome in patients with intermediate‐risk karyotype acute myeloid leukemia |
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