AUTHOR=Chen Yi , Wu Zhengjun , Chen Yanxin , Wang Zhengyang , Cai Ruyu , Wu Yong , Zheng Jing 

TITLE=Prognostic impact of methylation-related gene mutations in elderly acute myeloid leukemia: a real-world retrospective analysis

JOURNAL=Frontiers in Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1594784

DOI=10.3389/fmed.2025.1594784

ISSN=2296-858X

ABSTRACT=ObjectiveThis study aimed to evaluate the prognostic impact of methylation-related gene mutations in older patients with acute myeloid leukemia (AML).MethodsWe conducted a retrospective analysis of clinical characteristics in 645 patients aged ≥ 60 years diagnosed with AML at Fujian Medical University Union Hospital between July 2016 and December 2024.ResultsMethylation-related gene mutations—specifically DNMT3A, TET2, IDH1, and IDH2—were identified in 24.0%, 22.5%, 9.1%, and 13.8% of cases, respectively. Patients with single mutations in DNMT3A or TET2 exhibited similar long-term survival outcomes compared to those without these mutations, with median survival times of 25.2 and 22.3 months, respectively (p = 0.9639). However, patients with concurrent DNMT3A and TET2 mutations demonstrated the poorest treatment response and prognosis, achieving a complete remission (CR) rate of 35.5% and a median survival of only 6.2 months. In contrast, patients with IDH1/IDH2 mutations responded better to treatment, achieving a CR rate of 69.6% and a median survival of 34.7 months. Treatment regimens combining azacitidine and venetoclax did not provide additional improvement in treatment response for patients with methylation-related gene mutations compared to intensive chemotherapy (IC).ConclusionConcurrent mutations in DNMT3A and TET2 were associated with significantly poorer treatment response and survival outcomes. These common methylation-related gene mutations did not influence the choice between IC and azacitidine plus venetoclax combination therapy in elderly AML patients.