Impact of DNMT3A Gene Mutation on Response of Acute Myeloid Leukemia Patients to Induction Therapy

Aim: To evaluate the frequency and prognostic impact of DNA methyltransferase 3A (DNMT3A) gene mutation on response to induction therapy in newly diagnosed acute myeloid leukemia patients.

Study Design: Cross-sectional descriptive study.

Place and Duration: Hematology units of Suez Canal and Ain Shams schools of Medicine, Egypt. Between September 2016 and July 2017.

Methodology: The study enrolled forty patients (male: female ratio was 1; mean age was 52.4 ± 19.4 years) with newly diagnosed de novo AML before starting induction therapy. DNMT3A mutations were detected using dye terminator sequencing technique for the second part of DNMT3A, encompassing the PHD and methyltransferase domains and representing exons 11 till the last exon 23. Hematological, cytogenetic studies and DNMT3A mutation results were compared to the patients’ hematological response to induction therapy.

Results: Fourteen patients (35%) of the study participants had DNMT3A mutations while 65% had the wild type. Approximately 49.5% of mutations occurred in exon 23, the most common mutations were (R882C and R882H mutations; 28.5% and 21%, respectively). Out of 14 patients with DNMT3A mutation, 9 patients had incomplete remission and only 5 achieved complete remission with no statistically significant association. Odds ratio of the response to induction therapy according to DNMT3A mutation status was 1.32 times higher to show incomplete remission than in wild-DNMT3A patients.

Conclusion: DNMT3A mutation has high prevalence in AML Egyptian patients with non-statistically significant difference between mutated DNMT3A and wild type when related to the impact on remission rates after induction therapy.