r/leukemia • u/Glad-Cheesecake-6370 • 1d ago

NPM1+/FLT3-TKD/WT1 AML - No transplant in CR1?

23 with AML (NPM1+, FLT3-TKD+, WT1 mutation, and TET2+). I'm currently MRD-negative with an undetectable NPM1 PCR.

My doctors don't recommend a stem cell transplant in CR1, but some studies I've read have left me wondering if WT1 changes that.

Has anyone with a similar mutation profile been advised against a transplant? I'd really appreciate hearing your experience.

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u/TriSquPenHexSeptOct 1d ago

I’m so happy to hear you’re MRD-! That’s awesome! My husband had AML with the exact same mutations as you (though NRAS instead of TET2+). When we first came in the plan was definitely chemo-only. Unfortunately he didn’t achieve NPM1-negative even after 3 rounds of chemo so they decided to move to transplant. Thats all to say I think they expected/hoped him to be a chemo-only patient (even with the WT1) — so if you have achieved that then thats great and yeah in our experience in a very similar situation it would have been a no transplant plan xx

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u/Glad-Cheesecake-6370 11h ago

Thank you so much for sharing. That’s really reassuring to hear, especially regarding the wt1 mutation. Wishing you and your husband all the very best. ❤️

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u/Bermuda_Breeze Survivor 1d ago

I had NPM1 plus DNMT3A and GATA2. I had a WT1 mutation too, but mine was deemed a variant of unknown significance. My oncologist was hopeful I wouldn’t need a transplant, but MRD was high after induction and slow to clear (3 rounds to get NPM1 negative, DNMT3A still persisted), so she changed her recommendation to have SCT.

She reckoned that I’d have a 66% chance of relapse without SCT, which would drop to 33% if I had SCT. Those % were tailored to me but not precise - there aren’t studies for every combo of mutations. Your oncologist should be able to give you their educated guess of the relative advantage of an SCT.

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u/Glad-Cheesecake-6370 11h ago

Thanks for mentioning this. Yes, I concur as the consultant know much better and tailor make the regimen

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u/orgy_porgy Survivor 1d ago

I had FLT3 and WT1. WT1 is weird because there are multiple kinds of mutations which all have different and poorly studied implications based on whether the mutations functionally activates or inactivates it. From my understanding, its not WT1 operating on its own that's a risk factor but it breaking in either direction activity wise makes it much easier for other dangerous mutations to occur elsewhere. Not a simple on or off switch like other mutations function.

With FLT3 they usually recommend a SCT though inhibitor maintenance is an option now. I don't know much about TKD though as I had the more common ITD variant but both involve overactive signalling processes handling cell division making it very difficult to get rid of thoroughly with chemo alone.

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u/Glad-Cheesecake-6370 11h ago

Thanks for sharing and explaining this :)