RRML - Simultaneous FLT3, NPM1 and DNMT3A mutations in adult patients with acute myeloid leukemia

RRML - Simultaneous FLT3, NPM1 and DNMT3A mutations in adult patients with acute myeloid leukemia – case study

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Nr. 27(3)/2019 DOI:10.2478/rrlm-2019-0022

Research article

Simultaneous FLT3, NPM1 and DNMT3A mutations in adult patients with acute myeloid leukemia – case study

Florin Tripon, George Andrei Crauciuc, Valeriu George Moldovan, Alina Bogliș, István Jr Benedek, Erzsébet Lázár, Claudia Bănescu

Correspondence should be addressed to: Florin Tripon

Abstract:

Background: Nowadays, cytogenetics and molecular genetics, but not only, are mandatory in acute myeloid leukemia (AML) management, as a consequence of their impact on AML pathogenesis, classification, risk-stratification, prognosis and treatment. Objective: The aim of our study was to present our algorithm for the analysis of copy number changes, aneuploidies and somatic mutations focusing on a rare AML case positive for four somatic mutations. Methods: Cytogenetic analysis, Multiplex Ligationdependent Probe Amplification (MLPA) analysis, somatic mutation analysis (for FLT3 ITD, FLT3 D835, DNMT3A R882 and NPM1 c.863_864ins) by using several PCR techniques and also next-generation sequencing (NGS) analysis were performed. Results: Cytogenetic analysis did not reveal structural or numerical chromosomal anomalies. The patient’s DNA showed no copy number changes or aberrations (CNAs) following the MLPA analysis. By using several molecular technologies we found four mutations: FLT3-ITD, FLT3 D835 (c.2504A>T, D835V), DNMT3A R882C, and NPM1 c.863_864insTCTG. Challenges, benefits, applications and the limitations of each molecular technique used for the investigation of the mentioned mutation, and not only, are also described. Conclusion: All these techniques can be useful in the diagnosis of AML patients, each of them covering the limits of the other technique. New strategies for a positive, fast, accurate and reliable diagnosis are mandatory in cases with AML.

Keywords: acute myeloid leukemia, MLPA, NGS, FLT3, DNMT3A, NPM1

Received: 31.12.2018
Accepted: 18.3.2019
Published:

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Tripon F, Crauciuc GA, Moldovan VG, Bogliș A, Benedek IJ, Lázár E, et al. Simultaneous FLT3, NPM1 and DNMT3A mutations in adult patients with acute myeloid leukemia – case study. Rev Romana Med Lab. 2019;27(3):245-54. DOI:10.2478/rrlm-2019-0022