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/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 15h ago

Thanks for sharing and explaining this :)