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Microclone with megaimpact
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DOI：10.1182/blood.2026034528.png)
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Abstract
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In this issue of Blood, Duployez et al1 reported on the prognostic impact of FLT3-ITD microclones on the outcomes of patients with newly diagnosed acute myeloid leukemia (AML) treated with intensive chemotherapy (IC). This retrospective analyses included 1733 patients, aged 18 to 60 years, who were treated on the French BIG1 multicenter trial and evaluated the prognostic impact of FLT3-ITD macroclones (allelic ratio [AR] >= 0.05) through DNA fragment length analysis, FLT3-ITD microclones (AR 0.0004-0.0499) through next-generation sequencing (NGS)-based assay, and compared outcomes with patients with true FLT3-ITD-negative AML. All patients were treated homogenously with 7+3 IC followed by intermediate-or high-dose cytarabine consolidation. FLT3 microclones were detected in similar to 14% of the full cohort and in 17% of the patients who tested negative for FLT3 macroclones. Other studies have shown that FLT3 microclones are present in similar to 20% to 30% of patients with FLT3-negative AML and are associated with higher risks of relapse compared to completely FLT3-negative AML, often with clonal expansion of the FLT3 microclones at relapse.2,3
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